| NPI | 1972983344 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | AARON JON AFFLECK Physician/Owner 208-523-6868 |
| Organization Subpart ? | No |
| Primary Taxonomy | 332H00000X Eyewear Supplier (Licence: ID M8206) |
| Enumeration Date | 2015-06-01 |
| Last Update Date | 2015-06-01 |