| NPI | 1972941599 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | G F JENSEN O PT Ometrist/ Owner/LLC 920-235-8500 |
| Organization Subpart ? | No |
| Primary Taxonomy | 332H00000X Eyewear Supplier (Licence: WI 1506) |
| Enumeration Date | 2013-06-05 |
| Last Update Date | 2013-06-05 |