Organization
PAUL V HAKES OD INC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
PAUL V HAKES OD (OWNER)
(208) 634-2232
Entity
Organization
Contact information
Practice address
204 LENORA ST, MCCALL, ID 83638
(208) 634-2232
(208) 634-4716
Mailing address
PO BOX 1027, MCCALL, ID 83638-1027
(208) 634-2232
(208) 634-1746
Taxonomy
Speciality
Code
Description
License number
State
152W00000X
Optometrist
Primary
04761969
ID
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
000010015318
REGENCE BLUE SHIELD
—
05
—
002804100
—
ID
01
—
V0278
BLUE CROSS
—
Enumeration date
01/11/2006
Last updated
01/20/2010
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