| NPI | 1154690923 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | JENNIFER MARIE HOLMAN President 208-345-6886 |
| Organization Subpart ? | No |
| Primary Taxonomy | 152W00000X Optometrist (Licence: ID ODP-100213) |
| Enumeration Date | 2011-12-22 |
| Last Update Date | 2011-12-22 |