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General NPI Number Information
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NPI Number | 1407869589
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Entity Type | Organization
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Legal Business Name | ADA VISION CENTER P.A.
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Dates
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Enumeration Date | 08/13/2006
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Last Update Date | 08/01/2024
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Provider Practice Location Address
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Address Line | 1333 W JEFFERSON ST
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City | BOISE
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State | ID
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Zip | 83702-5320
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Country | US
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Telephone | 208-336-2020
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Fax | 208-384-5677
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Provider Business Mailing Address
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Address Line | 1333 W JEFFERSON ST
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City | BOISE
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State | ID
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Zip | 83702-5320
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Country | US
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Telephone | 208-336-2020
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Fax | 208-384-5677
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Authorized Official
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Title or Position | PRESIDENT
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Name | ERIN ROLFS
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Credential | PD
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Telephone | 208-336-2020
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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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