Organization
DR. PAUL E. KOCH, OPTOMETRIST, P.C
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. PAUL ERWIN KOCH O.D. (PRESIDENT)
(208) 290-2401
Entity
Organization
Contact information
Practice address
476999 HIGHWAY 95, C/O WALMART VISION CENTER, PONDERAY, ID 83852-9738
(208) 255-5513
(208) 255-5823
Mailing address
476999 HIGHWAY 95, PONDERAY, ID 83852-9738
(208) 255-5513
(208) 255-5823
Taxonomy
Speciality
Code
Description
License number
State
152W00000X
Optometrist
Primary
ODP1026
ID
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
806343800
—
ID
Enumeration date
04/14/2009
Last updated
02/26/2014
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