Healthcare Provider Details

I. General information

NPI: 1710382460
Provider Name (Legal Business Name): JFK VISION PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/23/2014
Last Update Date: 04/09/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7447 W EMERALD ST STE 105
BOISE ID
83704-5003
US

IV. Provider business mailing address

7447 W EMERALD ST STE 105
BOISE ID
83704-5003
US

V. Phone/Fax

Practice location:
  • Phone: 208-322-1642
  • Fax: 208-378-4179
Mailing address:
  • Phone: 208-322-1642
  • Fax: 208-378-4179

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code152W00000X
TaxonomyOptometrist
License NumberODP-100312
License Number StateID

VIII. Authorized Official

Name: DR. SPENCER FRANZ
Title or Position: OWNER
Credential: O.D.
Phone: 208-317-5200