Organization
IDAHO EYE PROS OF BOISE
Active
Organization subpart
No
Provider details
NPI number
Authorized official
LAVAR W KOFOED OD (OWNER)
(208) 378-7020
Entity
Organization
Contact information
Practice address
291 N MILWAUKEE ST, SUITE A3, BOISE, ID 83704-9132
(208) 297-7019
(208) 375-7970
Mailing address
291 N MILWAUKEE ST, SUITE A3, BOISE, ID 83704-9132
(208) 297-7019
(208) 375-7970
Taxonomy
Speciality
Code
Description
License number
State
152W00000X
Optometrist
Primary
—
—
Other
Enumeration date
04/15/2014
Last updated
04/15/2014
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