Organization
ASPEN RIDGE EYE CARE, PLLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. JERRY D CARLSON O.D. (OWNER)
(208) 528-6900
Entity
Organization
Contact information
Practice address
3456 E 17TH ST, SUITE 150, AMMON, ID 83406-6757
(208) 528-6900
(208) 528-6904
Mailing address
3456 E 17TH ST, SUITE 150, AMMON, ID 83406-6757
(208) 528-6900
(208) 528-6904
Taxonomy
Speciality
Code
Description
License number
State
152W00000X
Optometrist
Primary
ODP-100104
ID
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
807648800
—
ID
Enumeration date
05/11/2007
Last updated
05/01/2013
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