NPI age
20 years
Enumerated 2005-08-04
Across 16 active optometrist providers in Idaho.
| Type | Value | Notes |
|---|---|---|
| 01 | I-902428 | CHAMPUS |
| 01 | 0605250001 | DMERC |
| 01 (ID) | 82052 | BLUE SHIELD |
| 05 (ID) | 002543100 |
Part of a multi-provider practice. 2 other active providers share this practice address in NPPES.
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