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Organization

LAKESIDE EYECARE

Active
Organization subpart
No

Provider details

NPI number
Authorized official
DR. JOHN LLOYD CALDERWOOD O.D. (OWNER)
(208) 676-1422
Entity
Organization

Contact information

Practice address
312 N 4TH ST, COEUR D ALENE, ID 83814-2812
(208) 676-1422
(208) 667-7730
Mailing address
312 N 4TH ST, COEUR D ALENE, ID 83814-2812
(208) 676-1422
(208) 667-7730

Taxonomy

Speciality
Code
Description
License number
State
152W00000X
Optometrist
Primary
ODP-100067
ID

Other

Other identifiers
Code
Description
Identifier
Issuer
State
05
807139300
ID
Enumeration date
04/15/2009
Last updated
02/05/2010
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