Hayden Vision Source Pllc

NPI #1780345264 in Hayden, Idaho

Provider Information

NPI Number: 1780345264
Entity Type: Organization
Organization Name: Hayden Vision Source Pllc
Primary Specialty: Optometrist
Enumeration Date: Jan 6, 2022
Last Updated: Jul 6, 2022

Practice Location

Address: 8445 N GOVERNMENT WAY
City: Hayden
State: Idaho
ZIP Code: 83835-9349
Phone: (208) 772-3208

Authorized Official

Name: TYREL BRUNEEL, OD
Title: OWNER
Phone: (208) 772-3208

Specialties & Taxonomy Codes

Specialty	Taxonomy Code	Primary
Optometrist	152W00000X	Primary

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