NPI age
19 years
Enumerated 2006-08-26
Across 122 active ophthalmology providers in Idaho.
| Type | Value | Notes |
|---|---|---|
| 05 (ID) | 000223700 | |
| 01 | 180029065 | R/R MEDICARE |
| 01 (ID) | 11344491 | MEDICARE PTAN |
| 01 (ID) | 000010001691 | B/S |
| 01 (ID) | 19554 | B/C |
Part of a multi-provider practice. 18 other active providers share this practice address in NPPES.
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