Dr Wendell R Fackrell Pllc

NPI #1801171293 in Chubbuck, Idaho

Provider Information

NPI Number
1801171293
Entity Type
Organization
Organization Name
Dr Wendell R Fackrell Pllc
Primary Specialty
Optometrist
Enumeration Date
Oct 17, 2011
Last Updated
Oct 17, 2011

Practice Location

Address
4145 YELLOWSTONE AVE
State
Idaho
ZIP Code
83202-2421
Phone
(801) 722-5380

Authorized Official

Name
WENDELL FACKRELL, O. D.
Title
OPTOMETRIST, OWNER
Phone
(801) 722-5380

Specialties & Taxonomy Codes

Specialty
Optometrist

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