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General NPI Number Information
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NPI Number | 1326669920
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Entity Type | Organization
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Legal Business Name | CLEAR EYES OPTOMETRIC CARE, PLLC
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Dates
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Enumeration Date | 05/05/2020
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Last Update Date | 05/05/2020
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Provider Practice Location Address
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Address Line | 7950 HORSESHOE BEND RD STE 101
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City | BOISE
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State | ID
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Zip | 83714-3809
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Country | US
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Telephone | 208-504-8607
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Fax |
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Provider Business Mailing Address
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Address Line | 7950 HORSESHOE BEND RD STE 101
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City | BOISE
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State | ID
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Zip | 83714-3809
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Country | US
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Telephone | 208-504-8607
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | DR. BLAKE BINGHAM
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Credential | OD
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Telephone | 208-504-8607
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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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