Organization
VISION QUEST MEDICAL CENTER, PA
Active
Organization
VISION QUEST MEDICAL CENTER, PA
Active
Other names
Sonntag Eye Associates
Organization subpart
No
Provider details
NPI number
Authorized official
JACOB ADAM MONG DO (PRESIDENT)
(208) 377-3937
Entity
Organization
Contact information
Practice address
3025 W CHERRY LN, SUITE 207, MERIDIAN, ID 83642-1125
(208) 898-1614
(208) 898-1618
Mailing address
5680 W GAGE ST, BOISE, ID 83706-1326
(208) 377-3937
(208) 377-9455
Taxonomy
Speciality
Code
Description
License number
State
152W00000X
Optometrist
ODP-100002
ID
152W00000X
Optometrist
ODP-100417
ID
207W00000X
Ophthalmology Physician
Primary
O-0860
ID
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
000160500
—
ID
05
—
001553800
—
ID
01
—
46235
BLUE CROSS GROUP NO
ID
05
—
806834700
—
ID
05
—
807072200
—
ID
05
—
807072300
—
ID
Enumeration date
06/01/2007
Last updated
10/21/2021
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