Organization
WESTSIDE EYECARE INC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. JARED EDGAR BIRCH O.D. (PRESIDENT)
(208) 529-4333
Entity
Organization
Contact information
Practice address
1689 PANCHERI DR, IDAHO FALLS, ID 83402-3041
(208) 529-4333
(208) 529-4366
Mailing address
1689 PANCHERI DR, IDAHO FALLS, ID 83402-3041
(208) 529-4333
(208) 529-4366
Taxonomy
Speciality
Code
Description
License number
State
152W00000X
Optometrist
Primary
ODP-100057
ID
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
807631000
—
ID
Enumeration date
11/08/2006
Last updated
12/18/2012
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