STATE OF IDAHO

BOISE, ID
NPI1801833454
Entity TypeOrganization
Authorized ContactANGELA ROAN
Administrator
208-334-3220
Organization Subpart ?No
Primary Taxonomy152WL0500X Optometrist Low Vision Rehabilitation
Enumeration Date2006-06-01
Last Update Date2020-08-22
Business Address
STATE OF IDAHO
120 S COLE RD SUITE 120 - BLDG 3
BOISE, ID 83709-0932
Phone number: 208-334-3220
Mailing Address
STATE OF IDAHO
120 S COLE RD SUITE 120 - BLDG 3
BOISE, ID 83709-0932
Phone number: 208-334-3220
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