Organization
ADVANCED EYECARE OF BLACKFOOT PLLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. JERRY CARLSON O.D. (DOCTOR)
(208) 528-6900
Entity
Organization
Contact information
Practice address
1213 PARKWAY DR, BLACKFOOT, ID 83221-1654
(208) 782-3426
(208) 782-3436
Mailing address
1213 PARKWAY DR, BLACKFOOT, ID 83221-1654
(208) 782-3426
(208) 782-3436
Taxonomy
Speciality
Code
Description
License number
State
152W00000X
Optometrist
Primary
—
—
Other
Enumeration date
09/03/2008
Last updated
07/31/2015
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