| NPI | 1932976917 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | KIMBERLY CANONIC Sr Direcgtor 479-371-1168 |
| Organization Subpart ? | No |
| Primary Taxonomy | 156FX1800X Technician/Technologist Optician |
| Additional Taxonomies | 332H00000X Eyewear Supplier |
| Enumeration Date | 2023-12-08 |
| Last Update Date | 2025-10-02 |