Individual
DR. SHAWN C. SORENSON
Active
Sole proprietor
Provider details
NPI number
Gender
Man
Credential
O.D.
Contact information
Practice address
408 S EAGLE RD, EAGLE, ID 83616-6078
(208) 939-2773
(208) 938-5755
Mailing address
355 S EAGLE RD, EAGLE, ID 83616-5912
(208) 938-2015
(208) 938-5755
Taxonomy
Speciality
Code
Description
License number
State
152W00000X
Optometrist
Primary
ODP-1058
ID
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
806131200
—
ID
Enumeration date
04/17/2006
Last updated
02/13/2017
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