| NPI | 1629427372 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | ROBERT SORENSEN O PT Ometrist 208-772-3208 |
| Organization Subpart ? | No |
| Primary Taxonomy | 152W00000X Optometrist (Licence: ID ODP - 100363) |
| Enumeration Date | 2016-06-03 |
| Last Update Date | 2016-06-03 |