Organization
ARTISAN PEDIATRIC EYECARE LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
JEFFREY C JOHNSON OD (MANAGER)
(208) 489-1477
Entity
Organization
Contact information
Practice address
7960 W RIFLEMAN ST STE 110, BOISE, ID 83704-9064
(208) 489-1477
Mailing address
152 N AL FRESCO PL, BOISE, ID 83712-7599
(208) 866-9455
Taxonomy
Speciality
Code
Description
License number
State
152WP0200X
Pediatric Optometrist
Primary
—
—
152WS0006X
Sports Vision Optometrist
—
—
152WV0400X
Vision Therapy Optometrist
—
—
152WX0102X
Occupational Vision Optometrist
—
—
Other
Enumeration date
01/18/2019
Last updated
01/18/2019
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