Individual
MITCH CLAY MERRILL
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
O.D.
Contact information
Practice address
74 E 1ST S, REXBURG, ID 83440-1936
(208) 356-6911
(208) 356-3185
Mailing address
74 E 1ST S, REXBURG, ID 83440-1936
(208) 356-6911
(208) 356-3185
Taxonomy
Speciality
Code
Description
License number
State
152W00000X
Optometrist
Primary
ODP-100543
ID
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
ODP-100543
LICENSE
ID
Enumeration date
08/05/2021
Last updated
08/20/2021
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