Advanced Eyecare of Blackfoot Pllc

NPI #1568610574 in Blackfoot, Idaho

Provider Information

NPI Number: 1568610574
Entity Type: Organization
Organization Name: Advanced Eyecare of Blackfoot Pllc
Primary Specialty: Optometrist
Enumeration Date: Sep 3, 2008
Last Updated: Jul 31, 2015

Practice Location

Address: 1213 PARKWAY DR
City: Blackfoot
State: Idaho
ZIP Code: 83221-1654
Phone: (208) 782-3426

Authorized Official

Name: DR. JERRY CARLSON, O.D.
Title: DOCTOR
Phone: (208) 528-6900

Specialties & Taxonomy Codes

Specialty	Taxonomy Code	Primary
Optometrist	152W00000X	Primary

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