Full Name | |
---|---|
Type | Facility |
Speciality | Optometrist |
Location | 501 Main St., Kamiah, Idaho |
Accepts Medicare Assignments | Does not participate in Medicare Program. The facility may not accept medicare assignment. |
Identifier | Type | State | Issuer |
---|---|---|---|
1942352380 | NPI | - | NPPES |
807089100 | Medicaid | ID |
Taxonomy | Type | License (State) | Status |
---|---|---|---|
152W00000X | Optometrist | ODP-100032 (Idaho) | Primary |
Mailing Address | Practice Location Address |
---|---|
Po Box 247, Kamiah, ID 83536-0247 Ph: (208) 935-2020 | 501 Main St., Kamiah, ID 83536 Ph: (208) 935-2020 |