Organization
BINGHAM FAMILY VISION, LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
BROOKE CRANDALL (MANAGER)
(208) 785-2210
Entity
Organization
Contact information
Practice address
715 W JUDICIAL ST, BLACKFOOT, ID 83221-2036
(208) 785-2210
(208) 785-2216
Mailing address
715 W JUDICIAL ST, BLACKFOOT, ID 83221-2036
(208) 785-2210
(208) 785-2216
Taxonomy
Speciality
Code
Description
License number
State
152W00000X
Optometrist
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1215120696
—
ID
Enumeration date
09/27/2018
Last updated
09/27/2018
Update your record
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