| NPI | 1982121570 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | JOYCE PECK Administrative Asst 606-564-8794 |
| Organization Subpart ? | No |
| Primary Taxonomy | 156FX1800X Technician/Technologist Optician (Licence: KY 110718) |
| Additional Taxonomies | 332B00000X Durable Medical Equipment & Medical Supplies |
| 332H00000X Eyewear Supplier (Licence: KY 110718) | |
| Enumeration Date | 2017-08-24 |
| Last Update Date | 2022-07-21 |