NPI age
19 years
Enumerated 2007-01-02
Across 598 active optometrist providers in Idaho.
| Type | Value | Notes |
|---|---|---|
| 01 (ID) | 000010026621 | BLUE SHIELD |
| 05 (ID) | 805561900 | |
| 01 (ID) | V3918 | BLUE CROSS |
| 01 (ID) | 167539 | COLE |
Solo or small practice. No other active providers share this practice address in NPPES. This provider is listed as a sole proprietor.
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