Luke A. Randall Pllc | |
7319 W State St, Boise, ID 83714-6051 | |
(208) 853-4786 | |
Not Available |
Full Name | Luke A. Randall Pllc |
---|---|
Type | Facility |
Speciality | Optometrist |
Location | 7319 W State St, Boise, Idaho |
Accepts Medicare Assignments | Medicare enrolled and accepts medicare insurance. Providers at this facility may prescribe medicare part D drugs. |
Identifier | Type | State | Issuer |
---|---|---|---|
1184925737 | NPI | - | NPPES |
Taxonomy | Type | License (State) | Status |
---|---|---|---|
152W00000X | Optometrist | ODP-100164 (Idaho) | Primary |
Provider Name | Shemayne S Mccarthy |
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Provider Type | Practitioner - Optometry |
Provider Identifiers | NPI Number: 1578582581 PECOS PAC ID: 4587688916 Enrollment ID: I20060124000671 |
Provider Name | Luke A Randall |
---|---|
Provider Type | Practitioner - Optometry |
Provider Identifiers | NPI Number: 1376705293 PECOS PAC ID: 4082788062 Enrollment ID: I20080808000712 |
Provider Name | Dallas B Stevens |
---|---|
Provider Type | Practitioner - Optometry |
Provider Identifiers | NPI Number: 1174775332 PECOS PAC ID: 5597818120 Enrollment ID: I20090729000936 |
Mailing Address | Practice Location Address |
---|---|
Luke A. Randall Pllc 112 W Claire St, Meridian, ID 83646-7521 Ph: (208) 473-0172 | Luke A. Randall Pllc 7319 W State St, Boise, ID 83714-6051 Ph: (208) 853-4786 |
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