Specialty |
Taxonomy Code | Specialty Code | Provider Type | |
Optician |
156FX1800X | 96[5] | Optician | |
Preferred Provider Organization |
305R00000X |
| NPI # | 1699928309 |
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| LBN Legal business name | OUTER VISION CORP 2 | ||||||||
| Authorized official | DONNIE ANDERSON - (MANAGER/OPTICIAN) | ||||||||
| Entity | Organization | ||||||||
| Organization subpart 1 | No | ||||||||
| Enumeration date | 10/25/2008 | ||||||||
| Last updated | 10/28/2008 - About 18 years ago | ||||||||
| Identifiers |
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