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General NPI Number Information
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NPI Number | 1447496427
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Entity Type | Organization
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Legal Business Name | EAGLE EYE VISION SERVICES
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Dates
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Enumeration Date | 12/23/2008
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Last Update Date | 12/23/2008
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Provider Practice Location Address
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Address Line | 355 E. NEIDER AVENUE
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City | COEUR D'ALENE
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State | ID
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Zip | 83815
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Country | US
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Telephone | 208-676-7356
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Fax | 207-676-7384
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Provider Business Mailing Address
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Address Line | PO BOX 2592
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City | HAYDEN
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State | ID
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Zip | 83835
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Country | US
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Telephone | 208-676-7356
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Fax | 208-676-7384
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Authorized Official
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Title or Position | PRESIDENT
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Name | ROY LAVERN CLAPPER
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Credential | OD
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Telephone | 208-676-7356
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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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