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General NPI Number Information
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NPI Number | 1306564331
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Entity Type | Organization
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Legal Business Name | NORTH 45 EYE PLLC
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Dates
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Enumeration Date | 08/16/2022
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Last Update Date | 09/15/2022
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Provider Practice Location Address
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Address Line | 6348 MAIN ST
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City | BONNERS FERRY
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State | ID
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Zip | 83805-8519
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Country | US
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Telephone | 208-267-1087
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Fax | 208-267-2235
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Provider Business Mailing Address
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Address Line | 6348 MAIN ST
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City | BONNERS FERRY
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State | ID
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Zip | 83805-8519
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Country | US
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Telephone | 208-267-1087
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Fax | 208-267-2235
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Authorized Official
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Title or Position | OWNER
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Name | DANIELLE THOLL
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Credential | OD
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Telephone | 208-267-1087
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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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