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General NPI Number Information
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NPI Number | 1689136178
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Entity Type | Organization
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Legal Business Name | INLAND EYE CARE PLLC
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Dates
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Enumeration Date | 04/03/2019
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Last Update Date | 04/03/2019
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Provider Practice Location Address
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Address Line | 212 RODEO DR STE 410
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City | MOSCOW
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State | ID
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Zip | 83843-9794
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Country | US
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Telephone | 208-874-0020
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Fax | 208-874-0019
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Provider Business Mailing Address
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Address Line | 1390 SW LOST TRAIL DR
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City | PULLMAN
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State | WA
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Zip | 99163-5661
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Country | US
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Telephone | 443-223-9443
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Fax |
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Authorized Official
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Title or Position | OWNER/OPTOMETRIST
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Name | DR. ENJOLI OLEETA COOKE
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Credential | OD
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Telephone | 443-223-9443
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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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