Organization
GRAND TETON EYE & OPTICAL
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. CHAD LEWIS ROBERTS OD (OWNER)
(208) 787-2088
Entity
Organization
Contact information
Practice address
110 BUFFALO WAY STE A, JACKSON, WY 83002-8460
(307) 733-4905
Mailing address
PO BOX 613, VICTOR, ID 83455-0613
(208) 787-2088
Taxonomy
Speciality
Code
Description
License number
State
152W00000X
Optometrist
Primary
ODP-100010
ID
Other
Enumeration date
01/30/2007
Last updated
10/10/2007
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