Organization
SPOONER EYE CARE SC
Active
Other names
Spooner Eye Care
Organization subpart
No
Provider details
NPI number
Authorized official
MRS. SONDRA KAY SHELLITO (OFFICE MANAGER)
(715) 520-3606
Entity
Organization
Contact information
Practice address
1611 RIVER ST, PAYETTE, ID 83661-2073
(715) 520-3414
Mailing address
1611 RIVER ST, PAYETTE, ID 83661-2073
(715) 520-3414
Taxonomy
Speciality
Code
Description
License number
State
152W00000X
Optometrist
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
2200142
MEDICA
—
05
—
38723400
—
WI
Enumeration date
03/08/2006
Last updated
12/10/2019
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