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General NPI Number Information
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NPI Number | 1336359694
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Entity Type | Organization
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Legal Business Name | CLEARVIEW FAMILY EYECARE PLLC
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Dates
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Enumeration Date | 05/23/2007
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Last Update Date | 01/26/2009
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Provider Practice Location Address
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Address Line | 11513 W FAIRVIEW AVE SUITE 106
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City | BOISE
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State | ID
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Zip | 83713-7886
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Country | US
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Telephone | 208-322-8439
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Fax | 208-322-8430
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Provider Business Mailing Address
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Address Line | 11513 W FAIRVIEW AVE SUITE 106
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City | BOISE
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State | ID
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Zip | 83713-7886
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Country | US
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Telephone | 208-322-8439
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Fax | 208-322-8430
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Authorized Official
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Title or Position | OWNER
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Name | DR. CHARLES R NICHOLSON
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Credential | OD
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Telephone | 208-322-8439
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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 | ODP-100135
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License Number State | ID
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Taxonomy #2
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Taxonomy Code | 152W00000X
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Taxonomy Name | Optometrist
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License Number | ODP-100134
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License Number State | ID
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