NPI age
19 years
Enumerated 2006-12-26
Across 598 active optometrist providers in Idaho.
| Type | Value | Notes |
|---|---|---|
| 01 | V3900 | BL CROSS |
| 05 (MT) | 0483922 | |
| 05 (ID) | 002582600 | |
| 01 | 000010152218 | BL SHIELD |
Doing-business-as, former, and alternate names recorded by NPPES.
Single-site organization. Only one practice location on file.
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