Provider Demographics
NPI:1265688584
Name:POST FALLS OPTOMETRIC PHYSICIANS PLLC
Entity Type:Organization
Organization Name:POST FALLS OPTOMETRIC PHYSICIANS PLLC
Other - Org Name:POST FALLS OPTOMETRIC PHYSICIANS
Other - Org Type:Doing Business As
Authorized Official - Title/Position:BILLING SPECIALIST/ CLINIC MANAGER
Authorized Official - Prefix:MS
Authorized Official - First Name:MISSY
Authorized Official - Middle Name:H
Authorized Official - Last Name:DUNN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:208-773-7434
Mailing Address - Street 1:185 W 4TH AVE STE A
Mailing Address - Street 2:
Mailing Address - City:POST FALLS
Mailing Address - State:ID
Mailing Address - Zip Code:83854-4979
Mailing Address - Country:US
Mailing Address - Phone:208-773-7434
Mailing Address - Fax:208-777-0836
Practice Address - Street 1:185 W 4TH AVE
Practice Address - Street 2:STE A
Practice Address - City:POST FALLS
Practice Address - State:ID
Practice Address - Zip Code:83854-5089
Practice Address - Country:US
Practice Address - Phone:208-773-7434
Practice Address - Fax:208-777-0836
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-08-18
Last Update Date:2013-07-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IDODP- 100218152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
ID8082273Medicaid
IDU81141Medicare UPIN
ID6610780001Medicare NSC