Individual
DAMON SCOTT MORTENSEN
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
OD
Contact information
Practice address
49 E 1ST S, REXBURG, ID 83440-1966
(208) 356-4444
(208) 356-4445
Mailing address
49 E 1ST S, REXBURG, ID 83440-1966
(208) 356-4444
(208) 356-4445
Taxonomy
Speciality
Code
Description
License number
State
152W00000X
Optometrist
Primary
ODP-100185
ID
Other
Enumeration date
06/22/2009
Last updated
06/22/2009
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