Individual
DR. PAUL ERWIN KOCH
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
O.D.
Contact information
Practice address
476999 HIGHWAY 95, PONDERAY, ID 83852-9738
(208) 255-5513
(208) 255-5823
Mailing address
1455 JANISH DR, SANDPOINT, ID 83864-6244
(208) 255-4801
(208) 255-5823
Taxonomy
Speciality
Code
Description
License number
State
152W00000X
Optometrist
Primary
ODP-1026
ID
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
806343800
—
ID
Enumeration date
06/12/2006
Last updated
04/14/2009
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