| NPI | 1962775817 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | LAWRENCE EDMUND ROEL Owner/Provider 864-542-1308 |
| Organization Subpart ? | No |
| Primary Taxonomy | 332H00000X Eyewear Supplier (Equipment, not the service) (Licence: SC 120021119) |
| Enumeration Date | 2012-02-22 |
| Last Update Date | 2012-05-31 |