| |
212 W Ironwood Dr Ste B&c, Coeur D Alene, ID 83814-1403 | |
(208) 765-8078 | |
Not Available |
Full Name | |
---|---|
Type | Facility |
Speciality | Eyewear Supplier |
Location | 212 W Ironwood Dr Ste B&c, Coeur D Alene, Idaho |
Accepts Medicare Assignments | Medicare enrolled and accepts medicare insurance. Providers at this facility may prescribe medicare part D drugs. |
Identifier | Type | State | Issuer |
---|---|---|---|
1063078442 | NPI | - | NPPES |
Taxonomy | Type | License (State) | Status |
---|---|---|---|
152W00000X | Optometrist | (* (Not Available)) | Secondary |
332H00000X | Eyewear Supplier | (* (Not Available)) | Primary |
Provider Name | Terri L Haley |
---|---|
Provider Type | Practitioner - Optometry |
Provider Identifiers | NPI Number: 1114929817 PECOS PAC ID: 8022083302 Enrollment ID: I20040831000251 |
Provider Name | Tanya D Reid |
---|---|
Provider Type | Practitioner - Optometry |
Provider Identifiers | NPI Number: 1528010121 PECOS PAC ID: 5991748402 Enrollment ID: I20050606001022 |
Provider Name | Martin M Harris |
---|---|
Provider Type | Practitioner - Optometry |
Provider Identifiers | NPI Number: 1568710200 PECOS PAC ID: 7416252739 Enrollment ID: I20160224002852 |
Mailing Address | Practice Location Address |
---|---|
Po Box 19060, Green Bay, WI 54307-9060 Ph: () - | 212 W Ironwood Dr Ste B&c, Coeur D Alene, ID 83814-1403 Ph: (208) 765-8078 |