Organization
MAGIC VALLEY VISION PLLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. JENNIFER KAY RUPRECHT O.D. (OPTOMETRIST/SOLE OWNER)
(208) 749-1396
Entity
Organization
Contact information
Practice address
1952 ADDISON AVE E, TWIN FALLS, ID 83301-5304
(208) 749-1396
Mailing address
1952 ADDISON AVE E, TWIN FALLS, ID 83301-5304
(208) 749-1396
Taxonomy
Speciality
Code
Description
License number
State
332H00000X
Eyewear Supplier
Primary
ODP-1036
ID
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
000010139897
BLUE SHIELD
ID
Enumeration date
07/05/2012
Last updated
07/05/2012
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