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General NPI Number Information
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NPI Number | 1801830666
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Entity Type | Organization
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Legal Business Name | REXBURG VISION CENTER
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Dates
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Enumeration Date | 06/15/2006
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Last Update Date | 08/30/2017
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Provider Practice Location Address
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Address Line | 49 E 1ST S
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City | REXBURG
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State | ID
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Zip | 83440-1966
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Country | US
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Telephone | 208-356-4444
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Fax | 208-356-4445
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Provider Business Mailing Address
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Address Line | 49 E 1ST S PO BOX 577
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City | REXBURG
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State | ID
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Zip | 83440-1966
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Country | US
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Telephone | 208-356-4444
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Fax | 208-356-4445
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Authorized Official
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Title or Position | PARTNER
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Name | DR. DARREN HATCH
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Credential | OD
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Telephone | 208-356-4444
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 332H00000X
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Taxonomy Name | Eyewear Supplier
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License Number | ODP-100403
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License Number State | ID
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Taxonomy #2
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Taxonomy Code | 152W00000X
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Taxonomy Name | Optometrist
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License Number |
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License Number State |
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