| NPI | 1316663032 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | LANDON GRANGE Medical Director 208-506-7966 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QA1903X Clinic/Center Ambulatory Surgical |
| Additional Taxonomies | 261QS0132X Clinic/Center Ophthalmologic Surgery |
| Enumeration Date | 2022-10-14 |
| Last Update Date | 2023-08-22 |