Eyecenter PA

NPI #1174632244 in Ketchum, Idaho

Provider Information

NPI Number: 1174632244
Entity Type: Organization
Organization Name: Eyecenter PA
Subpart: Yes (part of a larger organization)
Parent Organization: EYECENTER PA
Primary Specialty: Optometrist
Enumeration Date: Aug 30, 2006
Last Updated: Jan 8, 2008

Practice Location

Address: 180 1ST AVE N
City: Ketchum
State: Idaho
ZIP Code: 83340-6129
Phone: (208) 726-3363

Authorized Official

Name: ROBERT B GRILL, OD
Title: OWNER OPTOMETRIST
Phone: (208) 734-9800

Specialties & Taxonomy Codes

Specialty	Taxonomy Code	Primary
Optometrist	152W00000X	Primary

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