| NPI | 1154590909 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | JOEL I BROWN President 208-983-0260 |
| Organization Subpart ? | No |
| Primary Taxonomy | 152W00000X Optometrist |
| Additional Taxonomies | 332H00000X Eyewear Supplier (Equipment, not the service) (Licence: ID 0-869) |
| Enumeration Date | 2008-02-26 |
| Last Update Date | 2012-05-17 |