| NPI | 1265816003 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | BRENDA HALEN Office Mgr 208-882-4662 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QA1903X Clinic/Center, Ambulatory Surgical |
| Additional Taxonomies | 207W00000X Ophthalmology |
| Enumeration Date | 2015-07-10 |
| Last Update Date | 2015-07-10 |