Organization
RETINA SPECIALISTS OF IDAHO, PLLC
Active
Organization
RETINA SPECIALISTS OF IDAHO, PLLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DENTON R. ROBERTS M.D. (OWNER)
(208) 938-5624
Entity
Organization
Contact information
Practice address
13923 W WAINWRIGHT DR, SUITE 301, BOISE, ID 83713-1969
(208) 938-5624
(208) 938-5764
Mailing address
13923 W WAINWRIGHT DR, SUITE 301, BOISE, ID 83713-1969
(208) 398-5624
(208) 938-5764
Taxonomy
Speciality
Code
Description
License number
State
207W00000X
Ophthalmology Physician
Primary
M-10066
ID
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
808025900
—
ID
Enumeration date
07/23/2008
Last updated
04/10/2012
Update your record
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