Individual
BRENT SEXAUER
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
OD
Contact information
Practice address
1175 W BOISE AVE, BOISE, ID 83706-3503
(208) 384-9194
Mailing address
685 N 4TH E, MOUNTAIN HOME, ID 83647-2134
(208) 599-4744
Taxonomy
Speciality
Code
Description
License number
State
152W00000X
Optometrist
Primary
100508
ID
Other
Enumeration date
06/29/2020
Last updated
06/29/2020
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