NPI age
20 years
Enumerated 2005-08-24
Across 598 active optometrist providers in Idaho.
| Type | Value | Notes |
|---|---|---|
| 01 (ID) | V5475 | BLUE CROSS OF ID |
| 01 (ID) | 000010015295 | REGENCEY OF IDAHO |
| 05 (ID) | 807007400 |
Part of a multi-provider practice. 6 other active providers share this practice address in NPPES.
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