Organization
NORTH IDAHO CATARACT & LASER CTR
Active
Organization subpart
No
Provider details
NPI number
Authorized official
ROBERT TABARACCI (CFO)
(208) 770-3818
Entity
Organization
Contact information
Practice address
1814 LINCOLN WAY, COEUR D ALENE, ID 83814-2540
(208) 667-2531
(208) 765-9385
Mailing address
1814 LINCOLN WAY, COEUR D ALENE, ID 83814-2540
(208) 667-2531
(208) 765-9385
Taxonomy
Speciality
Code
Description
License number
State
261QA1903X
Ambulatory Surgical Clinic/Center
Primary
—
—
261QS0132X
Ophthalmologic Surgery Clinic/Center
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
000010004566
REGENCE BLUE SHIELD OF ID
ID
05
—
0026786
—
ID
01
—
00943
BLUE CROSS OF IDAHO
ID
01
—
1194861278
DAVID WOLD
—
01
—
1336285345
D.JUSTIN STORMOGIPSON
—
01
—
1386780484
PATRICK PARDEN
—
01
—
1487790598
STEPHEN A MOSS
—
01
—
1538205638
RODERICK KENT
—
01
—
182044801
BLUESHIELD MED ADVANTAGE
ID
Enumeration date
01/29/2007
Last updated
03/12/2026
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