Wynn, Shane L
Wynn, Shane L is an individual health care provider with primary practice located at 2025 E 17Th St , Idaho Falls ID 83404. He recently has only one registered license in Eye and Vision Services Providers / Optometrist, which is considered as his primary health care specialty. Wynn, Shane L can be contacted via phone (208) 524-2025.Contact Information
Primary practice address
2025 E 17Th St
Idaho Falls ID 83404
Phone: (208) 524-2025
Fax: (208) 529-1924
Website:
Health care specialties
| Specialty | Code | License # | State |
|---|---|---|---|
| Eye and Vision Services Providers / Optometrist | 152W00000X | 00P10064 | Idaho |
Profile Details
| NPI number | 1427125491 |
|---|---|
| LBN Legal business name | Wynn, Shane L |
| Credentials | Doctor of Optometry (OD) |
| Entity | Individual |
| Sole proprietor 1 | No |
| Enumeration date | Nov 28th, 2006 |
| Last updated | Jul 8th, 2007 - about 17 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.
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