| NPI | 1114923471 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | LOUIS PENNOW Director 208-336-8700 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QA1903X Clinic/Center, Ambulatory Surgical |
| Additional Taxonomies | 261QS0132X Clinic/Center, Ophthalmologic Surgery |
| Enumeration Date | 2005-06-22 |
| Last Update Date | 2016-10-10 |