Organization
EYE CLINIC OF IDAHO FALLS,PA
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. DAVID R ANDERSON M.D. (MEDICAL DIRECTOR)
(208) 529-3937
Entity
Organization
Contact information
Practice address
530 S HOLMES AVE, IDAHO FALLS, ID 83401-4751
(208) 529-3937
(208) 524-4380
Mailing address
PO BOX 2410, IDAHO FALLS, ID 83403-2410
(208) 529-3937
(208) 524-4380
Taxonomy
Speciality
Code
Description
License number
State
207W00000X
Ophthalmology Physician
Primary
M3793
ID
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
00240930
—
ID
05
—
003572200
—
ID
01
—
1205974136
INDIVIDUAL NPI
ID
Enumeration date
06/25/2007
Last updated
09/15/2011
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