Individual
MR. MARK MATTHEW MCKELL
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
O.D.
Contact information
Practice address
2100 CALDWELL BLVD, NAMPA, ID 83651-1510
(208) 466-6895
Mailing address
2100 CALDWELL BLVD, NAMPA, ID 83651-1510
(208) 466-6895
Taxonomy
Speciality
Code
Description
License number
State
152W00000X
Optometrist
6271198-9934
UT
152W00000X
Optometrist
Primary
ODP-100119
ID
Other
Enumeration date
08/25/2006
Last updated
07/08/2007
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