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General NPI Number Information
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NPI Number | 1174105449
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Entity Type | Organization
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Legal Business Name | EYE EXAM NEAR ME PLLC
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Dates
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Enumeration Date | 04/26/2021
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Last Update Date | 06/27/2022
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Provider Practice Location Address
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Address Line | 3050 E MULLAN AVE
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City | POST FALLS
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State | ID
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Zip | 83854-8939
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Country | US
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Telephone | 208-762-8802
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Fax | 208-762-8802
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Provider Business Mailing Address
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Address Line | PO BOX 783
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City | HAYDEN
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State | ID
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Zip | 83835-0783
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Country | US
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Telephone | 208-449-9183
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Fax | 208-762-8802
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Authorized Official
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Title or Position | OWNER/OPTOMETRIST
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Name | BRANDON WATSON
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Credential | OD
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Telephone | 82-449-9183
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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 |
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License Number State |
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