Organization
CARMINE PETRACCA
Active
Other names
Bryden Family Vision
Organization subpart
No
Provider details
NPI number
Authorized official
DR. CARMINE PETRACCA O.D. (OWNER)
(208) 743-1761
Entity
Organization
Contact information
Practice address
939 BRYDEN AVE, LEWISTON, ID 83501-5057
(208) 743-1761
(208) 746-8042
Mailing address
939 BRYDEN AVE, LEWISTON, ID 83501-5057
(208) 743-1761
(208) 746-8042
Taxonomy
Speciality
Code
Description
License number
State
261QH0100X
Health Service Clinic/Center
Primary
ODP-634
ID
Other
Enumeration date
12/10/2013
Last updated
12/10/2013
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