Provider Demographics
NPI:1720297070
Name:DIDEHBANS LIMITED
Entity Type:Organization
Organization Name:DIDEHBANS LIMITED
Other - Org Name:PEARLEVISION
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT OWNER FRANCHASIE
Authorized Official - Prefix:MRS
Authorized Official - First Name:SUE
Authorized Official - Middle Name:
Authorized Official - Last Name:DIDEHBAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:208-461-1000
Mailing Address - Street 1:7447 W EMERALD ST
Mailing Address - Street 2:#105
Mailing Address - City:BOISE
Mailing Address - State:ID
Mailing Address - Zip Code:83704
Mailing Address - Country:US
Mailing Address - Phone:208-322-1642
Mailing Address - Fax:208-378-4178
Practice Address - Street 1:7447 W EMERALD ST
Practice Address - Street 2:#105
Practice Address - City:BOISE
Practice Address - State:ID
Practice Address - Zip Code:83704
Practice Address - Country:US
Practice Address - Phone:208-322-1642
Practice Address - Fax:208-378-4178
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-22
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ILA7965156FC0800X
IL25009156FX1800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Not Answered156FC0800XEye and Vision Services ProvidersTechnician/TechnologistContact LensGroup - Multi-Specialty
Not Answered156FX1800XEye and Vision Services ProvidersTechnician/TechnologistOpticianGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
ID00010015156OtherBLUE CROSS BLUE SHIELD
ID102190OtherEYEMED