| NPI | 1326550096 |
|---|---|
| Doing Business As | MAPLE GROVE EYE CLINIC |
| Entity Type | Organization |
| Authorized Contact | NATHAN B ANDERSON Personal Representative 208-344-7944 |
| Organization Subpart ? | No |
| Primary Taxonomy | 207W00000X Ophthalmology |
| Additional Taxonomies | 152W00000X Optometrist |
| Enumeration Date | 2017-11-02 |
| Last Update Date | 2019-04-10 |