Provider Demographics
NPI:1255456323
Name:RETINA CONSULTANTS OF IDAHO, PLLC
Entity type:Organization
Organization Name:RETINA CONSULTANTS OF IDAHO, PLLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:DR
Authorized Official - First Name:SCOTT
Authorized Official - Middle Name:C
Authorized Official - Last Name:SIMPSON
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:208-855-5950
Mailing Address - Street 1:3715 E OVERLAND ROAD
Mailing Address - Street 2:SUITE 250
Mailing Address - City:MERIDIAN
Mailing Address - State:ID
Mailing Address - Zip Code:83642
Mailing Address - Country:US
Mailing Address - Phone:208-855-5950
Mailing Address - Fax:208-855-5940
Practice Address - Street 1:3715 E OVERLAND ROAD
Practice Address - Street 2:SUITE 250
Practice Address - City:MERIDIAN
Practice Address - State:ID
Practice Address - Zip Code:83642
Practice Address - Country:US
Practice Address - Phone:208-855-5950
Practice Address - Fax:208-855-5940
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-20
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmologyGroup - Single Specialty