Organization
LITTLE MO'S OPTICAL BOUTIQUE
Active
Organization subpart
No
Provider details
NPI number
Authorized official
LYNN C ERICKSON OPTICIAN (OWNER)
(208) 664-4011
Entity
Organization
Contact information
Practice address
1720 LINCOLN WAY, COEURD ALENE, ID 83814
(208) 664-4011
(208) 664-4022
Mailing address
1720 LINCOLN WAY, COEURD ALENE, ID 83814
(208) 664-4011
(208) 664-4022
Taxonomy
Speciality
Code
Description
License number
State
156FX1800X
Optician
Primary
—
ID
332H00000X
Eyewear Supplier
—
ID
Other
Enumeration date
02/12/2007
Last updated
09/16/2008
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