Whalio Doctors

NPI 1003873852

Vision Quest Medical Center, PA

Organisation Durable Medical Equipment & Medical Supplies Boise, ID

Practice location

Address
5680 W Gage St, Boise, ID 83706-1326
Phone
(208) 377-3937
Fax
(208) 377-9455

Authorised official

Name
Jacob a Mong
Title
President
Phone
(208) 377-3937

Registered specialties (4)

Durable Medical Equipment & Medical Supplies Primary
Suppliers Taxonomy 332B00000X
Optometrist
Eye and Vision Services Providers Taxonomy 152W00000X Licence ODP-100002 (ID)
Optometrist
Eye and Vision Services Providers Taxonomy 152W00000X Licence ODP100417 (ID)
Ophthalmology Physician
Allopathic & Osteopathic Physicians Taxonomy 207W00000X Licence O-0860 (ID)

Registry record

NPI
1003873852
Entity type
Organization
NPI issued
26 Apr 2006
Record last updated
21 Nov 2017

Reproduced from NPPES, the federal provider registry. The date above is when the provider last updated their own entry, not when we fetched it - a record can be years old and still current in the registry.