Organization
VISION QUEST MEDICAL CENTER, PA
Active
Organization
VISION QUEST MEDICAL CENTER, PA
Active
Organization subpart
No
Provider details
NPI number
Authorized official
JACOB A MONG DO (PRESIDENT)
(208) 377-3937
Entity
Organization
Contact information
Practice address
5680 W GAGE ST, BOISE, ID 83706-1326
(208) 377-3937
(208) 377-9455
Mailing address
5680 W GAGE ST, BOISE, ID 83706-1326
(208) 377-3937
(208) 377-9455
Taxonomy
Speciality
Code
Description
License number
State
261QS0132X
Ophthalmologic Surgery Clinic/Center
—
—
332B00000X
Durable Medical Equipment & Medical Supplies
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
807072200
—
ID
05
—
807072300
—
ID
Enumeration date
05/01/2006
Last updated
07/27/2020
Update your record
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