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General NPI Number Information
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NPI Number | 1710042353
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Entity Type | Organization
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Legal Business Name | EYE CARE FOR YOU
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Dates
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Enumeration Date | 12/26/2006
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Last Update Date | 06/23/2008
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Provider Practice Location Address
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Address Line | 710 W. SUPERIOR ST. STE A
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City | SANDPOINT
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State | ID
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Zip | 83864
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Country | US
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Telephone | 208-263-9000
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Fax | 208-263-9589
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Provider Business Mailing Address
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Address Line | 710 W. SUPERIOR ST. STE A
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City | SANDPOINT
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State | ID
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Zip | 83864
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Country | US
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Telephone | 208-263-9000
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Fax | 208-263-9589
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Authorized Official
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Title or Position | OWNER PRESIDENT
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Name | DR. JULIE BETH GAGNON
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Credential | OD
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Telephone | 208-263-9000
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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 | ODP895
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License Number State | ID
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