# STATE OF IDAHO

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- **Entity:** Organization
- **Status:** Active
- **Other names:** Idaho Commission for the Blind & Visually Impaired
- **Organization subpart:** No

## Provider details

- **NPI number:** 1801833454
- **Authorized official:** MS. ANGELA ROAN (ADMINISTRATOR)
- **Authorized official phone:** (208) 334-3220

## Contact information

- **Practice address:** 120 S COLE RD, SUITE 120 - BLDG 3, BOISE, ID 83709-0932
- **Practice address phone:** (208) 334-3220
- **Practice address fax:** (208) 334-2963
- **Mailing address:** 120 S COLE RD, SUITE 120 - BLDG 3, BOISE, ID 83709-0932
- **Mailing address phone:** (208) 334-3220
- **Mailing address fax:** (208) 334-2963

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 152WL0500X | Low Vision Rehabilitation Optometrist | — | NULL | Yes |
| 152WL0500X | Low Vision Rehabilitation Optometrist | — | — | Yes |

## Other

- **Enumeration date:** 06/01/2006
- **Last updated:** 08/22/2020