NPIMap

Organization Active NPI

Panhandle Eye Clinics Chartered

  • Eyewear Supplier
  • St Maries, ID
National Provider Identifier
1275715757
Registry record updated Jul 2, 2010
On this page

Key facts

NPPES NPI Registry
Primary specialty
Eyewear SupplierTaxonomy code 332H00000X
License
ODD382 Issued in ID
Legal business name
PANHANDLE EYE CLINICS CHARTERED
Practice address
704 W College Ave
St Maries, ID 83861-1824
Phone
(208) 245-6563
Fax
(208) 245-6564
NPI assigned
Nov 27, 2007
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jul 2, 2010

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Dr. Robert D Magwire, OD
Title
Doctor/Owner
Phone
(208) 245-6563

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Eyewear Supplier 332H00000X ODD382 ID Primary

Addresses

Primary practice location

704 W College Ave
St Maries, ID 83861-1824

Mailing address

704 W College Ave
St Maries, ID 83861-1824
Phone (208) 245-6563

Other identifiers 3

IdentifierTypeStateIssuer
V0179OtherIDBLUE CROSS OF IDAHO
0000100159391OtherIDREGENCE BLUESHIELD
002692300MedicaidID

National Provider Directory

National Provider Directory

Locations

704 W College Ave
St Maries, ID 83861
Phone (208) 245-6563

Practitioners & affiliated clinicians

Practitioners 4

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1196121600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1278028800000",
    "number": "1275715757",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "704 W COLLEGE AVE",
            "city": "ST MARIES",
            "state": "ID",
            "postal_code": "838611824",
            "telephone_number": "208-245-6563",
            "fax_number": "208-245-6564"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "704 W COLLEGE AVE",
            "city": "ST MARIES",
            "state": "ID",
            "postal_code": "838611824",
            "telephone_number": "208-245-6563",
            "fax_number": "208-245-6564"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PANHANDLE EYE CLINICS CHARTERED",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-11-27",
        "last_updated": "2010-07-02",
        "status": "A",
        "authorized_official_last_name": "MAGWIRE",
        "authorized_official_first_name": "ROBERT",
        "authorized_official_middle_name": "D",
        "authorized_official_title_or_position": "DOCTOR/OWNER",
        "authorized_official_telephone_number": "208-245-6563",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "OD"
    },
    "taxonomies": [
        {
            "code": "332H00000X",
            "taxonomy_group": "",
            "desc": "Eyewear Supplier",
            "state": "ID",
            "license": "ODD382",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BLUE CROSS OF IDAHO",
            "identifier": "V0179",
            "state": "ID"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "REGENCE BLUESHIELD",
            "identifier": "0000100159391",
            "state": "ID"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "002692300",
            "state": "ID"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in St Maries, ID

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 2, 2010; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.