Provider Demographics
NPI:1699811646
Name:NORTH IDAHO EYE INSTITUTE, P.A.
Entity Type:Organization
Organization Name:NORTH IDAHO EYE INSTITUTE, P.A.
Other - Org Name:COEUR D ALENE EYE CLINIC POST FALLS EYE CLINIC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRACTICE ADMINISTRATOR
Authorized Official - Prefix:MS
Authorized Official - First Name:ALYSSE
Authorized Official - Middle Name:
Authorized Official - Last Name:CRANER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:208-667-2531
Mailing Address - Street 1:1814 LINCOLN WAY
Mailing Address - Street 2:
Mailing Address - City:COEUR D ALENE
Mailing Address - State:ID
Mailing Address - Zip Code:83814-2540
Mailing Address - Country:US
Mailing Address - Phone:208-667-2531
Mailing Address - Fax:208-765-9385
Practice Address - Street 1:1814 LINCOLN WAY
Practice Address - Street 2:
Practice Address - City:COEUR D ALENE
Practice Address - State:ID
Practice Address - Zip Code:83814-2540
Practice Address - Country:US
Practice Address - Phone:208-667-2531
Practice Address - Fax:208-765-9385
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-29
Last Update Date:2022-09-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
ID0023705Medicaid
ID000010018019OtherREGENCE BLUE SHIELD OF ID
1373644Medicare PIN