| NPI | 1942755160 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | KENNETH LAWRENCE GROLEAU Owner/ Dispensing Optician 904-276-4611 |
| Organization Subpart ? | No |
| Primary Taxonomy | 332H00000X Eyewear Supplier (Equipment, not the service) (Licence: FL do3062) |
| Enumeration Date | 2016-08-17 |
| Last Update Date | 2017-05-11 |