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General NPI Number Information
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NPI Number | 1992808182
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Entity Type | Organization
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Legal Business Name | BIG BLUE OPTICS, PC
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Dates
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Enumeration Date | 09/06/2006
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Last Update Date | 11/14/2007
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Provider Practice Location Address
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Address Line | 1410 BROADWAY AVE
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City | BOISE
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State | ID
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Zip | 83706-3706
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Country | US
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Telephone | 208-433-1410
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Fax | 208-433-1403
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Provider Business Mailing Address
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Address Line | 1410 BROADWAY AVE
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City | BOISE
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State | ID
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Zip | 83706-3706
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Country | US
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Telephone | 208-433-1410
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Fax | 208-433-1403
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. ROB DEE CHRISTENSEN
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Credential | O.D.
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Telephone | 208-433-1410
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 152W00000X
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Taxonomy Name | Optometrist
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License Number | ODP-100054
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License Number State | ID
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