| NPI | 1871643585 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | LOUIS M PENNOW Director 208-336-8700 |
| Organization Subpart ? | No |
| Primary Taxonomy | 207W00000X Ophthalmology (Licence: ID M6436) |
| Additional Taxonomies | 152W00000X Optometrist (Licence: ID ODP100159) |
| Enumeration Date | 2007-01-12 |
| Last Update Date | 2010-06-29 |