| NPI | 1992962658 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | MONIQUE RENE' MIKULA Owner/O PT Ometrist 970-356-9743 |
| Organization Subpart ? | No |
| Primary Taxonomy | 152W00000X Optometrist (Licence: CO OPT1684) |
| Additional Taxonomies | 332H00000X Eyewear Supplier (Licence: CO OPT1684) |
| Enumeration Date | 2008-05-20 |
| Last Update Date | 2008-05-20 |