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General NPI Number Information
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NPI Number | 1093189581
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Entity Type | Organization
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Legal Business Name | SOUTHERN IDAHO OPHTHALMOLOGY PLLC
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Dates
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Enumeration Date | 11/20/2015
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Last Update Date | 11/20/2015
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Provider Practice Location Address
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Address Line | 1415 PARKVIEW DR
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City | TWIN FALLS
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State | ID
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Zip | 83301-3250
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Country | US
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Telephone | 208-734-8934
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Fax | 208-734-8974
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Provider Business Mailing Address
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Address Line | 1415 PARKVIEW DR
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City | TWIN FALLS
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State | ID
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Zip | 83301-3250
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Country | US
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Telephone | 208-734-8934
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Fax | 208-734-8974
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. JAMES MORGAN COOMBS
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Credential | M.D.
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Telephone | 208-734-8934
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207W00000X
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Taxonomy Name | Ophthalmology Physician
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License Number | M4223
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License Number State | ID
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Taxonomy #2
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Taxonomy Code | 207W00000X
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Taxonomy Name | Ophthalmology Physician
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License Number | M12126
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License Number State | ID
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Taxonomy #3
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Taxonomy Code | 207W00000X
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Taxonomy Name | Ophthalmology Physician
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License Number | M9542
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License Number State | ID
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