Organization
CLEARWATER VALLEY OPTICAL
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. EUGENE M BALDECK M.D. (PHYSICIAN/OWNER)
(208) 743-2241
Entity
Organization
Contact information
Practice address
2214 VINEYARD AVE, LEWISTON, ID 83501-6352
(208) 743-2241
(208) 743-5871
Mailing address
2214 VINEYARD AVE, LEWISTON, ID 83501-6352
(208) 743-2241
Taxonomy
Speciality
Code
Description
License number
State
207W00000X
Ophthalmology Physician
Primary
M-2629
ID
Other
Enumeration date
08/23/2007
Last updated
08/23/2007
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