| NPI | 1669808846 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | KENDALL JOHNSON Manager 208-377-1310 |
| Organization Subpart ? | No |
| Primary Taxonomy | 152WV0400X Optometrist, Vision Therapy |
| Additional Taxonomies | 152WS0006X Optometrist, Sports Vision |
| Enumeration Date | 2013-09-19 |
| Last Update Date | 2013-09-19 |