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General NPI Number Information
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NPI Number | 1083743447
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Entity Type | Organization
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Legal Business Name | EYE CARE NORTHWEST PA
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Dates
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Enumeration Date | 03/03/2007
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Last Update Date | 02/11/2021
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Provider Practice Location Address
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Address Line | 251 SW 19TH ST
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City | ONTARIO
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State | OR
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Zip | 97914-1972
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Country | US
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Telephone | 208-639-2542
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Fax | 201-300-0138
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Provider Business Mailing Address
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Address Line | 2663 E PARKRIVER DR
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City | BOISE
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State | ID
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Zip | 83706-6083
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Country | US
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Telephone | 208-639-2542
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Fax | 201-300-0138
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Authorized Official
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Title or Position | MEDICAL DIRECTOR
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Name | JEFFREY TODD LIEGNER
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Credential | MD
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Telephone | 208-639-2542
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QH0100X
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Taxonomy Name | Health Service Clinic/Center
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License Number |
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License Number State |
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