Organization
PANHANDLE EYE CLINICS CHARTERED
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. ROBERT D MAGWIRE OD (DOCTOR/OWNER)
(208) 245-6563
Entity
Organization
Contact information
Practice address
704 W COLLEGE AVE, ST MARIES, ID 83861-1824
(208) 245-6563
(208) 245-6564
Mailing address
704 W COLLEGE AVE, ST MARIES, ID 83861-1824
(208) 245-6563
(208) 245-6564
Taxonomy
Speciality
Code
Description
License number
State
332H00000X
Eyewear Supplier
Primary
ODD382
ID
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
0000100159391
REGENCE BLUESHIELD
ID
05
—
002692300
—
ID
01
—
V0179
BLUE CROSS OF IDAHO
ID
Enumeration date
11/27/2007
Last updated
07/02/2010
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