| NPI | 1902078785 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | JILL MARIE LANE President/Physician 208-983-3732 |
| Organization Subpart ? | No |
| Primary Taxonomy | 152W00000X Optometrist (Licence: ID ODP-100095) |
| Enumeration Date | 2008-04-01 |
| Last Update Date | 2017-01-12 |