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1043620255
LANDON KELLY GRANGE
BOISE, ID
NPI
1043620255
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Entity Type
Individual
Gender
Male
Sole Proprietor ?
No
Primary Taxonomy
207W00000X Ophthalmology
(Licence: ID M14219)
Enumeration Date
2014-04-28
Last Update Date
2018-07-26
Business Address
LANDON KELLY GRANGE M.D.
5680 W GAGE ST
BOISE, ID 83706
Phone number: 208-773-3937
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Mailing Address
LANDON KELLY GRANGE M.D.
3867 MIRAMAR ST APARTMENT G
LA JOLLA, CA 92037-1312
Phone number: 208-559-6893
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