Organization
VISION QUEST MEDICAL CENTER, PA
Active
Organization
VISION QUEST MEDICAL CENTER, PA
Active
Other names
SONNTAG EYE ASSOCIATES, PA
Organization subpart
No
Provider details
NPI number
Authorized official
CINDY LEE CLANCY (CREDENTIALING)
(208) 377-3937
Entity
Organization
Contact information
Practice address
5680 W GAGE ST, BOISE, ID 83706-1326
(208) 377-3937
(208) 377-9455
Mailing address
5680 W GAGE ST, BOISE, ID 83706-1326
(208) 377-3937
(208) 377-9455
Taxonomy
Speciality
Code
Description
License number
State
152W00000X
Optometrist
ODP-100002
ID
152W00000X
Optometrist
ODP-100417
ID
207W00000X
Ophthalmology Physician
Primary
O-0860
ID
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
000160500
—
ID
05
—
001553800
—
ID
01
—
0857720001
DMERC GROUP NO
ID
05
—
806834700
—
ID
05
—
807072200
—
ID
05
—
807072300
—
ID
Enumeration date
05/29/2007
Last updated
04/06/2023
Update your record
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