Provider Demographics
NPI:1871849059
Name:PEND OREILLE VISION CARE
Entity type:Organization
Organization Name:PEND OREILLE VISION CARE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:NATHANEAL
Authorized Official - Middle Name:
Authorized Official - Last Name:HARRELL
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:208-265-7965
Mailing Address - Street 1:514 OAK ST
Mailing Address - Street 2:UNIT A
Mailing Address - City:SANDPOINT
Mailing Address - State:ID
Mailing Address - Zip Code:83864-1480
Mailing Address - Country:US
Mailing Address - Phone:208-265-7965
Mailing Address - Fax:208-265-7905
Practice Address - Street 1:514 OAK ST STE A
Practice Address - Street 2:
Practice Address - City:SANDPOINT
Practice Address - State:ID
Practice Address - Zip Code:83864-1480
Practice Address - Country:US
Practice Address - Phone:208-265-7965
Practice Address - Fax:208-265-7905
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-07-25
Last Update Date:2023-03-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center
Provider Identifiers
StateIdentifier IDID TypeIssuer
ID6696360001Medicare NSC