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General NPI Number Information
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NPI Number | 1780726455
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Entity Type | Organization
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Legal Business Name | LASERCARE CENTER OF IDAHO
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Dates
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Enumeration Date | 02/12/2007
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 360 E MALLARD DR STE 110
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City | BOISE
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State | ID
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Zip | 83706-3945
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Country | US
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Telephone | 208-336-8700
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Fax | 208-426-0902
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Provider Business Mailing Address
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Address Line | 360 E MALLARD DR STE 110
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City | BOISE
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State | ID
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Zip | 83706-3945
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Country | US
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Telephone | 208-336-8700
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Fax | 208-426-0902
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Authorized Official
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Title or Position | OFFICE MANAGER
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Name | SANDIE FELICE
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Credential |
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Telephone | 208-336-8700
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QS0132X
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Taxonomy Name | Ophthalmologic Surgery Clinic/Center
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License Number |
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License Number State | ID
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