| NPI | 1447328463 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | SHEREE C SHANNON Administrative Assistant 208-459-2641 |
| Organization Subpart ? | No |
| Primary Taxonomy | 152WC0802X Optometrist, Corneal and Contact Management (Licence: ID ODP-579) |
| Additional Taxonomies | 152W00000X Optometrist (Licence: ID ODP100163) |
| 152WC0802X Optometrist, Corneal and Contact Management (Licence: ID ODP100163) | |
| 152WP0200X Optometrist, Pediatrics (Licence: ID ODP100163) | |
| 152WL0500X Optometrist, Low Vision Rehabilitation (Licence: ID ODP100163) | |
| 152WX0102X Optometrist, Occupational Vision (Licence: ID ODP100163) | |
| 152WS0006X Optometrist, Sports Vision (Licence: ID ODP100163) | |
| 152W00000X Optometrist (Licence: ID ODP-579) | |
| 152WP0200X Optometrist, Pediatrics (Licence: ID ODP-579) | |
| Enumeration Date | 2006-11-30 |
| Last Update Date | 2010-06-28 |