MEDICARE: POST FALLS VISION CLINIC PLLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	152W00000X	Optometrist	ODP-499	ID

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
2	0430240001	OTHER	ID	MEDICARE DMERC

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	V7321	OTHER	ID	BLUE CROSS OF IDAHO

General Provider Information

NPI Number	:	1851476493
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	POST FALLS VISION CLINIC PLLC

Provider Business Mailing Address
First Line	:	2525 E SELTICE WAY
Second Line	:	PO BOX 997
City	:	POST FALLS
State	:	ID
Zip	:	83854-5089
Country	:	US
Telephone Number	:	208-773-7434
Fax Number	:	208-777-0836

Provider Business Practice Location Address
First Line	:	2525 E SELTICE WAY
Second Line	:
City	:	POST FALLS
State	:	ID
Zip	:	83854-5089
Country	:	US
Telephone Number	:	208-773-7434
Fax Number	:	208-777-0836

Authorized Official
Title or Position	:	OPTOMETRIST/OWNER
Name	:	ELWIN W. SCHUTT
Credential	:	O.D.
Telephone Number	:	208-773-7434

Provider Enumeration Date	:	10/25/2006
Last Update Date	:	08/14/2007

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Directions to “POST FALLS VISION CLINIC PLLC ” Practice Location

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