Organization
KEVIN COTTER ODPA
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. KEVIN COTTER OD (OWNER)
(208) 455-2197
Entity
Organization
Contact information
Practice address
5108 CLEVELAND BLVD, CALDWELL, ID 83607-8002
(208) 455-2197
(208) 455-2198
Mailing address
618 WINTHER BLVD, NAMPA, ID 83651-6542
(208) 466-1395
(208) 466-1395
Taxonomy
Speciality
Code
Description
License number
State
152W00000X
Optometrist
Primary
ODP-935
ID
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1592829
MEDICARE PROVIDER NUMBER
ID
Enumeration date
07/27/2007
Last updated
07/27/2007
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