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 |