Organization
EYE CLINIC OF SANDPOINT PA
Active
Organization subpart
No
Provider details
NPI number
Authorized official
JASON M PETERSEN OD (PHYSICIAN-OWNER)
(208) 263-8501
Entity
Organization
Contact information
Practice address
307 S 1ST AVE, SANDPOINT, ID 83864
(208) 263-8501
(208) 263-9713
Mailing address
307 S 1ST AVE, SANDPOINT, ID 83864-1201
(208) 263-8501
(208) 263-9713
Taxonomy
Speciality
Code
Description
License number
State
207W00000X
Ophthalmology Physician
Primary
—
—
332H00000X
Eyewear Supplier
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1215945431
—
ID
Enumeration date
08/03/2006
Last updated
06/19/2018
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