| NPI | 1083922918 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | PHILIP DAVID RAINEY Optometrist 208-461-2010 |
| Organization Subpart ? | No |
| Primary Taxonomy | 152W00000X Optometrist (Licence: ID ODP 100143) |
| Enumeration Date | 2010-09-14 |
| Last Update Date | 2010-09-14 |