| NPI | 1952692741 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | KIM PERUSKI Credentialing Coordinator 770-301-0231 |
| Organization Subpart ? | Yes |
| Primary Taxonomy | 332H00000X Eyewear Supplier (Equipment, not the service) |
| Enumeration Date | 2011-04-27 |
| Last Update Date | 2011-04-27 |