| NPI | 1780641902 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | JACOB A MONG President 208-377-3937 |
| Organization Subpart ? | No |
| Primary Taxonomy | 332B00000X Durable Medical Equipment & Medical Supplies |
| Additional Taxonomies | 261QS0132X Clinic/Center, Ophthalmologic Surgery |
| Enumeration Date | 2006-05-01 |
| Last Update Date | 2020-07-27 |