Organization
L. BROCK WREN OD PLLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
LEE BROCK WREN OD (OWNER)
(208) 376-0893
Entity
Organization
Contact information
Practice address
350 N MILWAUKEE ST, STE 1188, BOISE, ID 83704-9123
(208) 376-0893
(208) 376-3029
Mailing address
350 N MILWAUKEE ST, STE 1188, BOISE, ID 83704-9123
(208) 376-0893
(208) 376-3029
Taxonomy
Speciality
Code
Description
License number
State
152W00000X
Optometrist
Primary
ODP-100148
ID
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
808643800
—
ID
Enumeration date
12/16/2010
Last updated
12/16/2010
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