| NPI | 1336359694 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | CHARLES R NICHOLSON Owner 208-322-8439 |
| Organization Subpart ? | No |
| Primary Taxonomy | 152W00000X Optometrist (Licence: ID ODP-100134) |
| Additional Taxonomies | 152W00000X Optometrist (Licence: ID ODP-100135) |
| Enumeration Date | 2007-05-23 |
| Last Update Date | 2009-01-26 |