Individual
DR. GARY R. PABALIS
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
O.D.
Contact information
Practice address
5680 W GAGE ST, BOISE, ID 83706-1326
(208) 377-3937
(208) 377-9455
Mailing address
11972 W GAMEKEEPER DR, KUNA, ID 83634-2802
(208) 562-6285
(208) 377-9455
Taxonomy
Speciality
Code
Description
License number
State
152W00000X
Optometrist
114212-9934
UT
152W00000X
Optometrist
295
AZ
152W00000X
Optometrist
Primary
ODP-100002
ID
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
806834700
—
ID
Enumeration date
06/16/2005
Last updated
05/08/2023
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