Provider Demographics
NPI:1083922918
Name:PINNACLE VISION CARE, PLLC
Entity Type:Organization
Organization Name:PINNACLE VISION CARE, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OPTOMETRIST
Authorized Official - Prefix:DR
Authorized Official - First Name:PHILIP
Authorized Official - Middle Name:DAVID
Authorized Official - Last Name:RAINEY
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:208-461-2010
Mailing Address - Street 1:1213 N JACOB ALLCOTT WAY
Mailing Address - Street 2:
Mailing Address - City:NAMPA
Mailing Address - State:ID
Mailing Address - Zip Code:83687
Mailing Address - Country:US
Mailing Address - Phone:208-461-2010
Mailing Address - Fax:208-461-2013
Practice Address - Street 1:1213 NORTH JACOB ALLCOTT WAY
Practice Address - Street 2:
Practice Address - City:NAMPA
Practice Address - State:ID
Practice Address - Zip Code:83687
Practice Address - Country:US
Practice Address - Phone:208-461-2010
Practice Address - Fax:208-461-2013
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-09-14
Last Update Date:2010-09-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IDODP 100143152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty