Healthcare Provider Details

I. General information

NPI: 1629368725
Provider Name (Legal Business Name): REXFORD CAPITAL PARTNERS, INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/11/2011
Last Update Date: 08/03/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

649 SUN VALLEY ROAD
KETCHUM ID
83340
US

IV. Provider business mailing address

PO BOX 6
SUN VALLEY ID
83353-0006
US

V. Phone/Fax

Practice location:
  • Phone: 208-726-4250
  • Fax: 208-727-0082
Mailing address:
  • Phone: 208-726-4250
  • Fax: 208-727-0082

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code152W00000X
TaxonomyOptometrist
License NumberODP-100012
License Number StateID
# 2
Primary TaxonomyN
Taxonomy Code156FX1800X
TaxonomyOptician
License Number148134
License Number StateCA

VIII. Authorized Official

Name: MRS. LAURRINE MCGOWAN
Title or Position: OWNER
Credential: ABOC
Phone: 208-726-4250