Healthcare Provider Details

I. General information

NPI: 1518003516
Provider Name (Legal Business Name): NORTH IDAHO CATARACT & LASER CTR
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/29/2007
Last Update Date: 03/12/2026
Certification Date: 03/12/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1814 LINCOLN WAY
COEUR D ALENE ID
83814-2540
US

IV. Provider business mailing address

1814 LINCOLN WAY
COEUR D ALENE ID
83814-2540
US

V. Phone/Fax

Practice location:
  • Phone: 208-667-2531
  • Fax: 208-765-9385
Mailing address:
  • Phone: 208-667-2531
  • Fax: 208-765-9385

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QA1903X
TaxonomyAmbulatory Surgical Clinic/Center
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code261QS0132X
TaxonomyOphthalmologic Surgery Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: ROBERT TABARACCI
Title or Position: CFO
Credential:
Phone: 208-770-3818