Individual
JERRY BLAIR NAVE
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
OD
Contact information
Practice address
2550 S 25TH E, IDAHO FALLS, ID 83404
(208) 552-7323
(208) 552-7325
Mailing address
2550 S 25TH E, IDAHO FALLS, ID 83404
(208) 552-7323
(208) 552-7325
Taxonomy
Speciality
Code
Description
License number
State
152W00000X
Optometrist
Primary
0818
ID
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
004321400
—
ID
01
—
1307550001
NORIDIAN
ID
Enumeration date
08/30/2006
Last updated
11/10/2008
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