Organization
TETON VALLEY VISION PC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
THOMAS SIMMONS O.D. (OWNER)
20878739397
Entity
Organization
Contact information
Practice address
7389 S HWY 33, STE B, VICTOR, ID 83455
(208) 787-3937
Mailing address
7389 S HWY 33, STE B, VICTOR, ID 83455
Taxonomy
Speciality
Code
Description
License number
State
152W00000X
Optometrist
Primary
ODP-100009
ID
Other
Enumeration date
10/31/2014
Last updated
10/31/2014
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