Organization
IDAHO VISION DEVELOPMENT CENTER PLLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DANIEL NIELSON OD (OPTOMETRIST)
(208) 227-8822
Entity
Organization
Contact information
Practice address
1536 MIDWAY DR, AMMON, ID 83406-6912
(208) 227-8822
(208) 227-8966
Mailing address
1536 MIDWAY DR, AMMON, ID 83406-6912
(208) 227-8822
(208) 227-8966
Taxonomy
Speciality
Code
Description
License number
State
152WV0400X
Vision Therapy Optometrist
Primary
—
—
Other
Enumeration date
07/06/2019
Last updated
07/06/2019
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