Individual
DR. SHANE L WYNN
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
OD
Contact information
Practice address
2025 E 17TH ST, IDAHO FALLS, ID 83404
(208) 524-2025
(208) 529-1924
Mailing address
2025 E 17TH ST, IDAHO FALLS, ID 83404
(208) 524-2025
(208) 529-1924
Taxonomy
Speciality
Code
Description
License number
State
152W00000X
Optometrist
Primary
00P10064
ID
Other
Enumeration date
11/28/2006
Last updated
07/08/2007
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