L. Brock Wren OD PLLC

Primary specialty

OptometristTaxonomy code 152W00000X

License

ODP-100148 Issued in ID

Legal business name

L. BROCK WREN OD PLLC

Practice address

350 N Milwaukee St
Ste 1188
Boise, ID 83704-9123

Phone

(208) 376-0893

Fax

(208) 376-3029

NPI assigned

Dec 16, 2010

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Lee Brock Wren, OD

Title

Owner

Phone

(208) 376-0893

Specialties & licenses 1

Addresses

Other identifiers 1

Locations

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1292457600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1292457600000",
    "number": "1114220936",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "350 N MILWAUKEE ST",
            "address_2": "STE 1188",
            "city": "BOISE",
            "state": "ID",
            "postal_code": "837049123",
            "telephone_number": "208-376-0893",
            "fax_number": "208-376-3029"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "350 N MILWAUKEE ST",
            "address_2": "STE 1188",
            "city": "BOISE",
            "state": "ID",
            "postal_code": "837049123",
            "telephone_number": "208-376-0893",
            "fax_number": "208-376-3029"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "L. BROCK WREN OD PLLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2010-12-16",
        "last_updated": "2010-12-16",
        "status": "A",
        "authorized_official_last_name": "WREN",
        "authorized_official_first_name": "LEE",
        "authorized_official_middle_name": "BROCK",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "208-376-0893",
        "authorized_official_credential": "OD"
    },
    "taxonomies": [
        {
            "code": "152W00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Optometrist",
            "state": "ID",
            "license": "ODP-100148",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "808643800",
            "state": "ID"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Benjamin A Kuznia, DPT
• Kaci Kyle
• Cale Christopher Kynett, DC
• Kersten Kyrazis
• Savanna Kyser
• L. William D. Nowierski, M.D. PA
• Nancy Jane L'Heureux, DNP
• Luke La Mue, MD
• Julie N Labernik-Fabela, LCSW
• Tammy Labonne, MSED.

• Optometrist in Boise, ID
• Providers in Boise, ID by specialty
• Optometrist in Idaho

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 16, 2010; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.