Coeur Dalene Vision Source

LBN: Coeur Dalene Vision Source
Coeur Dalene Vision Source is an health care organization with primary practice located at 3879 N Schreiber Way , Coeur D Alene ID 83815-8362. The organization recently has only one registered license in Eye and Vision Services Providers / Optometrist, which is considered as the primary health care specialty. Coeur Dalene Vision Source can be contacted via phone (208) 765-2020, or through Greene, Raymond Karl via phone (208) 765-2020.

Contact Information

Primary practice address
3879 N Schreiber Way Coeur D Alene ID 83815-8362
Phone: (208) 765-2020
Fax: (208) 765-1460
Website:
Map and Directions
Authorized official contact:
Name: Greene, Raymond Karl Doctor of Optometry (OD)
Phone: (208) 765-2020

Health care specialties

SpecialtyCodeLicense #State
Eye and Vision Services Providers / Optometrist 152W00000X ODP845 Idaho

Profile Details

NPI number 1598881351
LBN Legal business name Coeur Dalene Vision Source
DBA Doing business as
Authorized official Greene, Raymond Karl Doctor of Optometry (OD)
Entity Organization
Organization subpart 1 No
Enumeration date Mar 22nd, 2007
Last updated Jun 19th, 2023 - about 2 years ago

1 Some organizations, which are providing health care services, may consist of units or departments that provide different types of health care services or have several separate physical locations, where health care service is provided. These units, departments or physical locations are not themselves legal entities. However, each of them is part of the organization, which is a legal entity. The organization may decide whether its subparts, if it has any, should have their own NPI numbers. In case a subpart conducts any HIPAA standard transactions by itself, without its parent's involvement, it must have its own NPI number.

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Identifiers

StateTypeNumberIssuer
All States NPI 1598881351 NPPES
Idaho MEDICAID 807085000

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