Individual
BRIAN WALTER DAVIS
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
OD
Contact information
Practice address
4270 N EAGLE RD, BOISE, ID 83713-0726
(208) 938-2010
(208) 938-2011
Mailing address
4270 N EAGLE RD, BOISE, ID 83713-0726
(208) 938-2010
(208) 938-2011
Taxonomy
Speciality
Code
Description
License number
State
152W00000X
Optometrist
1028
NV
152W00000X
Optometrist
Primary
ODP100516
ID
Other
Enumeration date
06/20/2019
Last updated
05/02/2022
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