| NPI | 1487128823 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | JEFFREY C JOHNSON Manager 208-489-1477 |
| Organization Subpart ? | No |
| Primary Taxonomy | 152WP0200X Optometrist, Pediatrics |
| Additional Taxonomies | 152WS0006X Optometrist, Sports Vision |
| 152WV0400X Optometrist, Vision Therapy | |
| 152WX0102X Optometrist, Occupational Vision | |
| Enumeration Date | 2019-01-18 |
| Last Update Date | 2019-01-18 |