Organization
HOLLINGSHEAD EYE CENTER, PC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
LOUIS M PENNOW MBA (DIRECTOR)
(208) 336-8700
Entity
Organization
Contact information
Practice address
360 E MALLARD DR, SUITE 110, BOISE, ID 83706-6644
(208) 336-8700
(208) 426-0902
Mailing address
360 E MALLARD DR, SUITE 110, BOISE, ID 83706-6644
(208) 336-8700
(208) 426-0902
Taxonomy
Speciality
Code
Description
License number
State
152W00000X
Optometrist
ODP100159
ID
207W00000X
Ophthalmology Physician
Primary
M6436
ID
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
805858400
—
ID
05
—
805858500
—
ID
Enumeration date
01/12/2007
Last updated
06/29/2010
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