Organization
SOUTHERN IDAHO VISION ALLIANCE,PLLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
JON E HEITZMAN OD (CEO)
(208) 735-0036
Entity
Organization
Contact information
Practice address
2051 TRAIL CREEK CIR, TWIN FALLS, ID 83301-8352
(208) 735-0036
Mailing address
2051 TRAIL CREEK CIR, TWIN FALLS, ID 83301-8352
(208) 735-0036
Taxonomy
Speciality
Code
Description
License number
State
152W00000X
Optometrist
Primary
ODP-495
ID
Other
Enumeration date
08/31/2006
Last updated
08/22/2020
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