Organization
LAWRENCE D ANDERSON MD ESTATE
Active
Other names
Maple Grove Eye Clinic
Organization subpart
No
Provider details
NPI number
Authorized official
MR. NATHAN B ANDERSON (PERSONAL REPRESENTATIVE)
(208) 344-7944
Entity
Organization
Contact information
Practice address
8955 W HACKAMORE DR, BOISE, ID 83709
(208) 344-7944
(208) 343-4676
Mailing address
8955 W HACKAMORE DR, BOISE, ID 83709
(208) 344-7944
(208) 343-4676
Taxonomy
Speciality
Code
Description
License number
State
152W00000X
Optometrist
—
—
207W00000X
Ophthalmology Physician
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1326302548
—
ID
05
—
1942316054
—
ID
Enumeration date
11/02/2017
Last updated
04/10/2019
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