| 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 |