NPI 1043620255

Landon Kelly Grange, MD

Practitioner Ophthalmology Physician Boise, ID

Practice location

Address: 5680 W Gage St, Boise, ID 83706
Phone: (208) 773-3937
Fax: (208) 377-3937
Mailing address: 3867 Miramar St Apartment G, La Jolla, CA 92037-1312

Registered specialties

Ophthalmology Physician Primary

Allopathic & Osteopathic Physicians Taxonomy 207W00000X Licence M14219 (ID)

Other Ophthalmology providers in Idaho →

Registry record

NPI: 1043620255
Entity type: Individual
Sex (as registered): Male
NPI issued: 28 Apr 2014
Record last updated: 26 Jul 2018

Reproduced from NPPES, the federal provider registry. The date above is when the provider last updated their own entry, not when we fetched it - a record can be years old and still current in the registry.