Organization
LEWISTON EYE CLINIC PA
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. EUGENE MEEHAN BALDECK MD (OWNER)
(208) 743-2241
Entity
Organization
Contact information
Practice address
2214 VINEYARD AVE, LEWISTON, ID 83501
(208) 743-2241
(208) 743-5871
Mailing address
2214 VINEYARD AVE, LEWISTON, ID 83501
(208) 743-2241
(208) 743-5871
Taxonomy
Speciality
Code
Description
License number
State
207W00000X
Ophthalmology Physician
Primary
M2629
ID
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1022144
—
WA
01
—
173777
COMBINED INS CO OF AMER
—
01
—
209714100000
PREMERA
—
01
—
26294
BLUE CROSS
ID
01
—
548D7BA
BLUE LINKS
—
01
—
D205000
REGENCE
ID
Enumeration date
08/21/2006
Last updated
08/22/2020
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