NPI | 1992198675 |
---|---|
Former Legal Business Name | WALLACE L CHRISTENSENSEN, OD |
Entity Type | Organization |
Authorized Contact | WALLACE L CHRISTENSEN Owner/Optometrist 208-237-7666 |
Organization Subpart ? | No |
Primary Taxonomy | 152W00000X Optometrist (Licence: ID ODP-0721) |
Enumeration Date | 2015-03-05 |
Last Update Date | 2015-03-05 |