Merrill, Mitch Clay
Merrill, Mitch Clay is an sole proprietor health care provider with primary practice located at 74 E 1St S , Rexburg ID 83440-1936. He recently has only one registered license in Eye and Vision Services Providers / Optometrist, which is considered as his primary health care specialty. Merrill, Mitch Clay can be contacted via phone (208) 356-6911.Contact Information
Primary practice address
74 E 1St S
Rexburg ID 83440-1936
Phone: (208) 356-6911
Fax: (208) 356-3185
Website:
Health care specialties
| Specialty | Code | License # | State |
|---|---|---|---|
| Eye and Vision Services Providers / Optometrist | 152W00000X | ODP-100543 | Idaho |
Profile Details
| NPI number | 1518631282 |
|---|---|
| LBN Legal business name | Merrill, Mitch Clay |
| Credentials | Doctor of Optometry (OD) |
| Entity | Individual |
| Sole proprietor 1 | Yes |
| Enumeration date | Aug 5th, 2021 |
| Last updated | Aug 20th, 2021 - about 4 years ago |
1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.
Identifiers
| State | Type | Number | Issuer |
|---|---|---|---|
| All States | NPI | 1518631282 | NPPES |
| Idaho | Other | ODP-100543 | LICENSE |
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