Organization
ADVANCED VISION THERAPY CENTER LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
KENDALL JOHNSON (MANAGER)
(208) 377-1310
Entity
Organization
Contact information
Practice address
7960 W RIFLEMAN ST, SUITE 150, BOISE, ID 83704-9064
(208) 377-1310
(208) 321-1952
Mailing address
7960 W RIFLEMAN ST, SUITE 150, BOISE, ID 83704-9064
(208) 377-1310
(208) 321-1952
Taxonomy
Speciality
Code
Description
License number
State
152WS0006X
Sports Vision Optometrist
—
—
152WV0400X
Vision Therapy Optometrist
Primary
—
—
Other
Enumeration date
09/19/2013
Last updated
09/19/2013
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