| NPI | 1255170205 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | JAREN OLSEN Owner 208-557-3222 |
| Organization Subpart ? | No |
| Primary Taxonomy | 152W00000X Optometrist |
| Additional Taxonomies | 152WL0500X Optometrist, Low Vision Rehabilitation |
| Enumeration Date | 2024-05-20 |
| Last Update Date | 2024-05-20 |