Organization
DALLAS STEVENS OD PA
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DALLAS STEVENS OD PA (OPTOMETRIST/ OWNER)
(208) 376-2062
Entity
Organization
Contact information
Practice address
8359 W EMERALD ST, BOISE, ID 83704-8304
(209) 376-2062
Mailing address
8359 W EMERALD ST, BOISE, ID 83704-8304
(209) 376-2062
Taxonomy
Speciality
Code
Description
License number
State
152W00000X
Optometrist
Primary
ODP100186
ID
Other
Enumeration date
02/20/2018
Last updated
02/20/2018
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