Provider Demographics
NPI:1306400429
Name:IDAHO RETINA CENTER PLLC
Entity Type:Organization
Organization Name:IDAHO RETINA CENTER PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MD
Authorized Official - Prefix:DR
Authorized Official - First Name:ALI
Authorized Official - Middle Name:
Authorized Official - Last Name:TORAB PARHIZ
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:208-322-5996
Mailing Address - Street 1:901 N CURTIS RD STE 302
Mailing Address - Street 2:
Mailing Address - City:BOISE
Mailing Address - State:ID
Mailing Address - Zip Code:83706-1341
Mailing Address - Country:US
Mailing Address - Phone:208-322-5996
Mailing Address - Fax:
Practice Address - Street 1:901 N CURTIS RD STE 302
Practice Address - Street 2:
Practice Address - City:BOISE
Practice Address - State:ID
Practice Address - Zip Code:83706-1341
Practice Address - Country:US
Practice Address - Phone:248-495-9553
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-04-24
Last Update Date:2021-08-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmologyGroup - Single Specialty