Diamond Peak Idaho

NPI #1588039127 in Rexburg, Idaho

Provider Information

NPI Number: 1588039127
Entity Type: Organization
Organization Name: Diamond Peak Idaho
Primary Specialty: Optometrist
Enumeration Date: Dec 8, 2015
Last Updated: Feb 4, 2016

Practice Location

Address: 1450 N 2ND E
City: Rexburg
State: Idaho
ZIP Code: 83440-5131
Phone: (208) 497-6406

Authorized Official

Name: WADE DEMORDAUNT, O.D.
Title: OWNER
Phone: (925) 222-1957

Specialties & Taxonomy Codes

Specialty	Taxonomy Code	Primary
Optometrist	152W00000X	Primary

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