| NPI | 1669877098 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | BRANDON CLARK NIELSEN O PT Ometrist 208-284-0650 |
| Organization Subpart ? | No |
| Primary Taxonomy | 152W00000X Optometrist (Licence: ID ODP-100311) |
| Enumeration Date | 2014-10-28 |
| Last Update Date | 2014-10-28 |