NPI age
19 years
Enumerated 2006-10-04
Across 598 active optometrist providers in Idaho.
| Type | Value | Notes |
|---|---|---|
| 05 (ID) | 003410000 | |
| 01 (PA) | 721912 | BLUE SHIELD |
| 01 (ID) | V7169 | BLUE CROSS / TRUE BLUE |
| 01 (ID) | 82304 | BLUE SHIELD |
Part of a multi-provider practice. 3 other active providers share this practice address in NPPES.
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