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General NPI Number Information
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NPI Number | 1548405327
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Entity Type | Organization
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Legal Business Name | EYE CARE FOR YOU LLC
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Dates
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Enumeration Date | 12/09/2008
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Last Update Date | 10/03/2022
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Provider Practice Location Address
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Address Line | 134 N STATE ST SUITE A
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City | PRESTON
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State | ID
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Zip | 83263-1143
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Country | US
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Telephone | 208-852-3030
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Fax | 208-852-3031
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Provider Business Mailing Address
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Address Line | 134 N STATE ST SUITE A
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City | PRESTON
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State | ID
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Zip | 83263-1143
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Country | US
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Telephone | 208-852-3030
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Fax | 208-852-3031
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. PHILIP CROMWELL
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Credential | OD
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Telephone | 208-852-3030
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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 | ODP607
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License Number State | ID
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