NPI age
19 years
Enumerated 2006-06-22
Across 598 active optometrist providers in Idaho.
| Type | Value | Notes |
|---|---|---|
| 05 (WA) | 2012219 | |
| 05 (ID) | 004322700 |
Part of a multi-provider practice. 1 other active provider shares this practice address in NPPES.
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