| NPI | 1972188803 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | MICHELLE S. MITTICA Optician/Manager 575-388-4464 |
| Organization Subpart ? | Yes |
| Primary Taxonomy | 156FX1800X Technician/Technologist, Optician |
| Enumeration Date | 2021-03-11 |
| Last Update Date | 2021-03-11 |