Organization
OPTIC ART II, P.C.
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. RODGER DEAN ROBERTSON O.D. (OPTOMETRIC PHYSICIAN)
(208) 882-2932
Entity
Organization
Contact information
Practice address
213 N MAIN ST, MOSCOW, ID 83843-2700
(208) 882-2932
Mailing address
213 N MAIN ST, MOSCOW, ID 83843-2700
(208) 882-2932
Taxonomy
Speciality
Code
Description
License number
State
152W00000X
Optometrist
Primary
ODP-552
ID
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
805042600
—
ID
Enumeration date
08/07/2009
Last updated
01/13/2012
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