| NPI | 1962123315 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | DAVID CROOKE Administrator 208-342-5151 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QA1903X Clinic/Center, Ambulatory Surgical |
| Additional Taxonomies | 261QS0132X Clinic/Center, Ophthalmologic Surgery |
| Enumeration Date | 2022-09-05 |
| Last Update Date | 2023-08-22 |