Individual
BRIAN J. MCGOURTY
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
O.D.
Contact information
Practice address
310 2ND ST S, NAMPA, ID 83651-3765
(208) 467-1361
(208) 467-9008
Mailing address
310 2ND ST S, NAMPA, ID 83651-3765
(208) 467-1361
(208) 467-9008
Taxonomy
Speciality
Code
Description
License number
State
152W00000X
Optometrist
Primary
0-592
ID
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
000010015424
REGENCE BLUE SHIELD
ID
05
—
002622300
—
ID
01
—
82049686583651A001
TRICARE
ID
01
—
E00820496865
AETNA
ID
01
—
V9063
BLUE CROSS
ID
Enumeration date
09/12/2006
Last updated
06/28/2010
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