Individual
DR. PAUL BIGELOW
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
O.D.
Contact information
Practice address
230 W MALLARD DR STE A, BOISE, ID 83706-3995
(208) 342-4841
(208) 343-9553
Mailing address
230 W MALLARD DR STE A, BOISE, ID 83706-3995
(208) 342-4841
(208) 343-9553
Taxonomy
Speciality
Code
Description
License number
State
152W00000X
Optometrist
Primary
ODP-577
ID
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
0026587
—
ID
01
—
P00419679
RAILROAD MEDICARE
ID
Enumeration date
06/27/2005
Last updated
12/17/2017
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