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General NPI Number Information
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NPI Number | 1134204100
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Entity Type | Organization
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Legal Business Name | EYECARE ASSOCIATES OF NAMPA PA
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Dates
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Enumeration Date | 10/26/2006
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Last Update Date | 07/25/2008
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Provider Practice Location Address
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Address Line | 310 2ND ST S
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City | NAMPA
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State | ID
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Zip | 83651-3765
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Country | US
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Telephone | 208-467-1361
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Fax | 208-467-9008
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Provider Business Mailing Address
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Address Line | 310 2ND ST S
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City | NAMPA
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State | ID
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Zip | 83651-3765
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Country | US
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Telephone | 208-467-1361
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Fax | 208-467-9008
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. BRIAN J. MCGOURTY
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Credential | O.D.
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Telephone | 208-467-1361
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 152W00000X
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Taxonomy Name | Optometrist
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License Number | 0-592
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License Number State | ID
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