Individual
MARISA DENISE BROWN
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
ODP
Contact information
Practice address
11513 W FAIRVIEW AVE STE 106, BOISE, ID 83713-7887
(208) 322-8439
Mailing address
816 W FRANKLIN ST, BOISE, ID 83702-5530
(206) 715-7232
Taxonomy
Speciality
Code
Description
License number
State
152W00000X
Optometrist
Primary
100511
ID
Other
Enumeration date
06/22/2020
Last updated
06/22/2020
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