=====================================================
General NPI Number Information
=====================================================
NPI Number | 1902810757
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | MOUNTAIN WEST OPTICAL INC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 07/28/2006
-----------------------------------------------------
Last Update Date | 09/11/2025
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 731 N COLLEGE RD
-----------------------------------------------------
City | TWIN FALLS
-----------------------------------------------------
State | ID
-----------------------------------------------------
Zip | 83301
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 208-734-3937
-----------------------------------------------------
Fax | 208-734-7585
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 731 N COLLEGE RD
-----------------------------------------------------
City | TWIN FALLS
-----------------------------------------------------
State | ID
-----------------------------------------------------
Zip | 83301
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 208-734-3937
-----------------------------------------------------
Fax | 208-734-7585
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | SECRETARY OF CORPORATION
-----------------------------------------------------
Name | SHIRLENE TRANMER
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 208-734-3937
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 332H00000X
-----------------------------------------------------
Taxonomy Name | Eyewear Supplier
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 152W00000X
-----------------------------------------------------
Taxonomy Name | Optometrist
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------