Individual
MRS. SUE SOROOR DIDEHBAN
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
7447 W EMERALD ST STE 105, BOISE, ID 83704-5003
(208) 322-1642
(208) 378-4179
Mailing address
7447 W EMERALD ST STE 105, BOISE, ID 83704-5003
(208) 322-1642
(208) 378-4179
Taxonomy
Speciality
Code
Description
License number
State
156FX1800X
Optician
Primary
000666777S
ID
Other
Enumeration date
10/29/2012
Last updated
10/29/2012
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