Organization
INTERMOUNTAIN OCULAR PROSTHETICS, INC.
Active
Organization
INTERMOUNTAIN OCULAR PROSTHETICS, INC.
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MR. SAM F MURANO II BCO, BADO (PRESIDENT)
(208) 378-8200
Entity
Organization
Contact information
Practice address
2308 W OVERLAND RD, BOISE, ID 83705-3152
(208) 378-8200
Mailing address
2308 W OVERLAND RD, BOISE, ID 83705-3152
(208) 378-8200
Taxonomy
Speciality
Code
Description
License number
State
332B00000X
Durable Medical Equipment & Medical Supplies
Primary
—
—
332BC3200X
Customized Equipment (DME)
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
0005600854
—
MT
05
—
113182600
—
WY
05
—
278130
—
OR
05
—
805051400
—
ID
Enumeration date
09/26/2006
Last updated
02/13/2009
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