| NPI | 1598940421 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | JAIMEN DIXON Owner 208-375-3871 |
| Organization Subpart ? | No |
| Primary Taxonomy | 152W00000X Optometrist |
| Additional Taxonomies | 152WC0802X Optometrist Corneal and Contact Management |
| Enumeration Date | 2008-01-09 |
| Last Update Date | 2023-08-04 |