MEDICARE: POST FALLS OPTOMETRIC PHYSICIANS PLLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	152W00000X	Optometrist	ODP- 100218	ID

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1265688584
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	POST FALLS OPTOMETRIC PHYSICIANS PLLC

Provider Business Mailing Address
First Line	:	185 W 4TH AVE STE A
Second Line	:
City	:	POST FALLS
State	:	ID
Zip	:	83854-4979
Country	:	US
Telephone Number	:	208-773-7434
Fax Number	:	208-777-0836

Provider Business Practice Location Address
First Line	:	185 W 4TH AVE
Second Line	:	STE A
City	:	POST FALLS
State	:	ID
Zip	:	83854-5089
Country	:	US
Telephone Number	:	208-773-7434
Fax Number	:	208-777-0836

Authorized Official
Title or Position	:	BILLING SPECIALIST/ CLINIC MANAGER
Name	:	MS. MISSY H DUNN
Credential	:
Telephone Number	:	208-773-7434

Provider Enumeration Date	:	08/18/2008
Last Update Date	:	07/26/2013

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