Organization
ANNS EYEWEAR BOUTIQUE INC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MRS. ANN RENE BRAGA OPTICIAN (OWNER)
(208) 733-1067
Entity
Organization
Contact information
Practice address
691 SHOSHONE ST N, TWIN FALLS, ID 83301
(208) 733-1067
Mailing address
691 SHOSHONE ST N, TWIN FALLS, ID 83301-6154
(208) 733-1067
Taxonomy
Speciality
Code
Description
License number
State
332H00000X
Eyewear Supplier
Primary
601I
AZ
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
000010014411
BLUE SHEILD OF IDAHO
ID
01
—
V2894
BLUE CROSS OF IDAHO
ID
Enumeration date
12/17/2007
Last updated
06/05/2008
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