Organization
VISION CARE CENTER OF IDAHO LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MRS. NANCY MCHUGH (ADMINISTRATOR)
(208) 288-1400
Entity
Organization
Contact information
Practice address
3071 E FRANKLIN RD, SUITE 101, MERIDIAN, ID 83642-2376
(208) 288-1400
(208) 855-0104
Mailing address
3071 E FRANKLIN RD, SUITE 101, MERIDIAN, ID 83642-2376
(208) 288-1400
(208) 855-0104
Taxonomy
Speciality
Code
Description
License number
State
261QA1903X
Ambulatory Surgical Clinic/Center
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
000010029517
BLUE SHILED
ID
01
—
04101
BLUE CROSS
ID
05
—
805861000
—
ID
01
—
FIRST HEALTH CCN
2090664
ID
Enumeration date
03/23/2006
Last updated
07/13/2010
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