Individual
DR. NATHAN CODY MORTENSEN
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
OD
Contact information
Practice address
49 E 1ST S, REXBURG, ID 83440-1966
(208) 356-4444
Mailing address
1340 FAIRVIEW AVE, REXBURG, ID 83440-5078
(208) 351-4170
Taxonomy
Speciality
Code
Description
License number
State
152W00000X
Optometrist
Primary
100403
ID
Other
Enumeration date
05/26/2017
Last updated
05/26/2017
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