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218 East Ellis Street, Paul, ID 83347 | |
(208) 629-6173 | |
Not Available |
Full Name | |
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Type | Facility |
Speciality | Optometrist |
Location | 218 East Ellis Street, Paul, Idaho |
Accepts Medicare Assignments | Medicare enrolled and accepts medicare insurance. Providers at this facility may prescribe medicare part D drugs. |
Identifier | Type | State | Issuer |
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1790529030 | NPI | - | NPPES |
Taxonomy | Type | License (State) | Status |
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152W00000X | Optometrist | (* (Not Available)) | Primary |
Provider Name | Eric Woodward |
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Provider Type | Practitioner - Optometry |
Provider Identifiers | NPI Number: 1114410305 PECOS PAC ID: 5698021723 Enrollment ID: I20200203002561 |
Mailing Address | Practice Location Address |
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Po Box 182, Paul, ID 83347-0182 Ph: () - | 218 East Ellis Street, Paul, ID 83347 Ph: (208) 629-6173 |