NPI age
19 years
Enumerated 2007-01-04
Across 74 active eyewear supplier providers in Idaho.
1 individual provider on file at this primary practice address.
| Type | Value | Notes |
|---|---|---|
| 05 (ID) | 002622500 | |
| 01 (ID) | V6622 | BLUE CROSS |
| 01 (ID) | 000010015349 | BLUE SHIELD |
Multi-provider organization. 1 individual provider on file at this primary address.
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