| NPI | 1982972410 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | MATTHEW D FORD Owner 330-343-1215 |
| Organization Subpart ? | No |
| Primary Taxonomy | 156FX1800X Technician/Technologist Optician (Licence: OH 4045S) |
| Additional Taxonomies | 332H00000X Eyewear Supplier (Licence: OH 4045S) |
| Enumeration Date | 2011-12-12 |
| Last Update Date | 2012-07-13 |