| NPI | 1477053007 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | DALLAS STEVENS O PT Ometrist/ Owner 208-376-2062 |
| Organization Subpart ? | No |
| Primary Taxonomy | 152W00000X Optometrist (Licence: ID ODP100186) |
| Enumeration Date | 2018-02-20 |
| Last Update Date | 2018-02-20 |