Individual
DR. H. SCOTT MORTENSEN III
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
(208) 356-4445
Mailing address
49 E 1ST S, PO BOX 577, REXBURG, ID 83440-1966
(208) 356-4444
(208) 356-4445
Taxonomy
Speciality
Code
Description
License number
State
152W00000X
Optometrist
Primary
ODP-0654
ID
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
002488500
—
ID
Enumeration date
06/22/2006
Last updated
08/26/2008
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