| NPI | 1518377704 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | BRANDON BENNETT CRAWFORD Optometrist 208-373-7926 |
| Organization Subpart ? | No |
| Primary Taxonomy | 152W00000X Optometrist (Licence: ID ODP-100179) |
| Enumeration Date | 2014-04-28 |
| Last Update Date | 2014-04-28 |