Organization
PAUL BIGELOW OD PC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
PAUL BIGELOW O.D. (PRESIDENT)
(208) 342-4841
Entity
Organization
Contact information
Practice address
415 E PARKCENTER BLVD, SUITE 127, BOISE, ID 83706-6504
(208) 342-4841
Mailing address
415 E PARKCENTER BLVD, SUITE 127, BOISE, ID 83706-6504
(208) 342-4841
Taxonomy
Speciality
Code
Description
License number
State
152W00000X
Optometrist
Primary
ODP-577
ID
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
DG1593
RAILROAD MEDICARE
ID
Enumeration date
08/05/2007
Last updated
11/21/2007
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