| NPI | 1598825416 |
|---|---|
| Doing Business As | VISION SOURCE BOISE |
| Doing Business As | VISION SPECIALTIES |
| Entity Type | Organization |
| Authorized Contact | CHAD H CLARK Owner/Doctor 208-322-8381 |
| Organization Subpart ? | No |
| Primary Taxonomy | 152W00000X Optometrist |
| Additional Taxonomies | 152W00000X Optometrist (Licence: ID ODP-682) |
| Enumeration Date | 2006-12-11 |
| Last Update Date | 2021-10-07 |