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General NPI Number Information
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NPI Number | 1477793222
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Entity Type | Organization
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Legal Business Name | COMPLETE FAMILY EYE CARE, PA
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Dates
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Enumeration Date | 03/05/2009
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Last Update Date | 02/22/2010
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Provider Practice Location Address
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Address Line | 34 SE MAIN ST STE 101
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City | BLACKFOOT
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State | ID
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Zip | 83221-5094
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Country | US
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Telephone | 208-785-7274
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Fax |
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Provider Business Mailing Address
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Address Line | 34 SE MAIN ST STE 101
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City | BLACKFOOT
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State | ID
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Zip | 83221-5094
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Country | US
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Telephone | 208-785-7274
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Fax |
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. CODY E JONES
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Credential | O,D.
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Telephone | 208-242-7900
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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-100178
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License Number State | ID
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