| |
425 Pine St, Wallace, ID 83873-2256 | |
(208) 752-2020 | |
(208) 556-7971 |
Full Name | |
---|---|
Type | Facility |
Speciality | Optometrist |
Location | 425 Pine St, Wallace, Idaho |
Accepts Medicare Assignments | Does not participate in Medicare Program. The facility may not accept medicare assignment. |
Identifier | Type | State | Issuer |
---|---|---|---|
1497769186 | NPI | - | NPPES |
000783200 | Medicaid | ID |
Taxonomy | Type | License (State) | Status |
---|---|---|---|
152W00000X | Optometrist | 0640 (Idaho) | Primary |
Mailing Address | Practice Location Address |
---|---|
425 Pine St, Wallace, ID 83873-2256 Ph: (208) 752-2020 | 425 Pine St, Wallace, ID 83873-2256 Ph: (208) 752-2020 |
Dr. Dick L Vester, O.D. Optometrist Medicare: Not Enrolled in Medicare Practice Location: 425 Pine St, Wallace, ID 83873 Phone: 208-752-2020 Fax: 208-556-7971 |