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General NPI Number Information
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NPI Number | 1275715757
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Entity Type | Organization
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Legal Business Name | PANHANDLE EYE CLINICS CHARTERED
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Dates
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Enumeration Date | 11/27/2007
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Last Update Date | 07/02/2010
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Provider Practice Location Address
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Address Line | 704 W COLLEGE AVE
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City | ST MARIES
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State | ID
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Zip | 83861-1824
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Country | US
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Telephone | 208-245-6563
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Fax | 208-245-6564
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Provider Business Mailing Address
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Address Line | 704 W COLLEGE AVE
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City | ST MARIES
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State | ID
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Zip | 83861-1824
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Country | US
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Telephone | 208-245-6563
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Fax | 208-245-6564
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Authorized Official
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Title or Position | DOCTOR/OWNER
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Name | DR. ROBERT D MAGWIRE
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Credential | OD
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Telephone | 208-245-6563
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 332H00000X
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Taxonomy Name | Eyewear Supplier
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License Number | ODD382
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License Number State | ID
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