| |
403 Bunker Ave, Kellogg, ID 83837-2205 | |
(208) 784-1141 | |
(208) 784-1142 |
Full Name | |
---|---|
Type | Facility |
Speciality | Optometrist |
Location | 403 Bunker Ave, Kellogg, Idaho |
Accepts Medicare Assignments | Does not participate in Medicare Program. The facility may not accept medicare assignment. |
Identifier | Type | State | Issuer |
---|---|---|---|
1609994631 | NPI | - | NPPES |
Taxonomy | Type | License (State) | Status |
---|---|---|---|
152W00000X | Optometrist | ODP 100109 (Idaho) | Primary |
Mailing Address | Practice Location Address |
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403 Bunker Ave, Kellogg, ID 83837-2205 Ph: (208) 784-1141 | 403 Bunker Ave, Kellogg, ID 83837-2205 Ph: (208) 784-1141 |