| NPI | 1003873852 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | JACOB A MONG President 208-377-3937 |
| Organization Subpart ? | No |
| Primary Taxonomy | 332B00000X Durable Medical Equipment & Medical Supplies |
| Additional Taxonomies | 152W00000X Optometrist (Licence: ID ODP-100002) |
| 152W00000X Optometrist (Licence: ID ODP100417) | |
| 207W00000X Ophthalmology (Licence: ID O-0860) | |
| Enumeration Date | 2006-04-26 |
| Last Update Date | 2017-11-21 |