NPI age
20 years
Enumerated 2006-01-30
Across 598 active optometrist providers in Idaho.
| Type | Value | Notes |
|---|---|---|
| 01 (ID) | 1243380001 | DMERC |
| 01 (ID) | V6630 | BLUE CROSS |
| 01 (ID) | 000010015349 | BLUE SHIELD |
| 05 (ID) | 002622500 |
Part of a multi-provider practice. 1 other active provider shares this practice address in NPPES.
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