Organization
DSM OPTOMETRY LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. DAMON SCOTT MORTENSEN OD (OWNER/DR.)
(208) 525-8964
Entity
Organization
Contact information
Practice address
2300 E 17TH ST, IDAHO FALLS, ID 83404-6504
(208) 525-8964
(208) 524-6562
Mailing address
652 MILL STREAM ST, REXBURG, ID 83440-5385
(208) 821-0016
(208) 524-6562
Taxonomy
Speciality
Code
Description
License number
State
152W00000X
Optometrist
Primary
ODP-100185
ID
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1760619365
NPI
ID
05
—
808388100
—
ID
Enumeration date
06/16/2011
Last updated
06/16/2011
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