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General NPI Number Information
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NPI Number | 1760279681
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Entity Type | Organization
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Legal Business Name | EYE PROS COEUR D ALENE LLC
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Dates
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Enumeration Date | 04/23/2025
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Last Update Date | 04/23/2025
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Provider Practice Location Address
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Address Line | 7307 N CULTURE
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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 | 833-776-2020
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Fax |
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Provider Business Mailing Address
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Address Line | 3485 N COLE RD UNIT 45479
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City | BOISE
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State | ID
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Zip | 83711-1095
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Country | US
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Telephone | 833-776-2020
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Fax |
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Authorized Official
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Title or Position | CREDENTIALING MANAGER
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Name | MRS. LAUREL GEORGE
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Credential |
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Telephone | 208-954-9106
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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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