| NPI | 1154616258 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | DAMON SCOTT MORTENSEN Owner/Dr. 208-525-8964 |
| Organization Subpart ? | No |
| Primary Taxonomy | 152W00000X Optometrist (Licence: ID ODP-100185) |
| Enumeration Date | 2011-06-16 |
| Last Update Date | 2011-06-16 |