| NPI | 1629615158 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | CODY JONES Owner 208-785-7274 |
| Organization Subpart ? | No |
| Primary Taxonomy | 152W00000X Optometrist |
| Additional Taxonomies | 152WV0400X Optometrist, Vision Therapy |
| Enumeration Date | 2019-12-03 |
| Last Update Date | 2020-01-16 |