Organization
VISTEC LLC
Active
Other names
Wallace L Christensensen, OD
Organization subpart
No
Provider details
NPI number
Authorized official
DR. WALLACE L CHRISTENSEN O.D. (OWNER/OPTOMETRIST)
(208) 237-7666
Entity
Organization
Contact information
Practice address
1246 YELLOWSTONE AVE STE A4, POCATELLO, ID 83201-4372
(208) 237-7666
Mailing address
1246 YELLOWSTONE AVE STE A4, POCATELLO, ID 83201-4372
(208) 237-7666
(208) 237-7400
Taxonomy
Speciality
Code
Description
License number
State
152W00000X
Optometrist
Primary
ODP-0721
ID
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
002875500
—
ID
Enumeration date
03/05/2015
Last updated
03/05/2015
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