| NPI | 1568693786 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | JUSTIN RODNEY JOHNSEN Owner 208-377-5433 |
| Organization Subpart ? | No |
| Primary Taxonomy | 207WX0200X Ophthalmology, Ophthalmic Plastic and Reconstructive Surgery |
| Additional Taxonomies | 207W00000X Ophthalmology |
| Enumeration Date | 2009-08-05 |
| Last Update Date | 2019-09-03 |