Clearwater Valley Optical

Primary specialty

Ophthalmology PhysicianTaxonomy code 207W00000X

License

M-2629 Issued in ID

Legal business name

CLEARWATER VALLEY OPTICAL

Practice address

2214 Vineyard Ave
Lewiston, ID 83501-6352

Phone

(208) 743-2241

Fax

(208) 743-5871

NPI assigned

Aug 23, 2007

Organization subpart

No

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

Authorized official

Name

Dr. Eugene M Baldeck, M.D.

Title

Physician/Owner

Phone

(208) 743-2241

Specialties & licenses 1

Addresses

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

{
    "created_epoch": "1187827200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1187827200000",
    "number": "1457544306",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2214 VINEYARD AVE",
            "city": "LEWISTON",
            "state": "ID",
            "postal_code": "835016352",
            "telephone_number": "208-743-2241"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2214 VINEYARD AVE",
            "city": "LEWISTON",
            "state": "ID",
            "postal_code": "835016352",
            "telephone_number": "208-743-2241",
            "fax_number": "208-743-5871"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "CLEARWATER VALLEY OPTICAL",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-08-23",
        "last_updated": "2007-08-23",
        "status": "A",
        "authorized_official_last_name": "BALDECK",
        "authorized_official_first_name": "EUGENE",
        "authorized_official_middle_name": "M",
        "authorized_official_title_or_position": "PHYSICIAN/OWNER",
        "authorized_official_telephone_number": "208-743-2241",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "M.D."
    },
    "taxonomies": [
        {
            "code": "207W00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Ophthalmology",
            "state": "ID",
            "license": "M-2629",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Clearwater Neurosciences PLLC
• Clearwater Neurosurgery & Spinal Surgery Associates PLLC
• Clearwater Operations, LLC
• Clearwater Orthotics & Prosthetics
• Clearwater Orthotics and Prosthetics, LLC
• Clearwater Vein Care Center PC
• Carrie Ann Coen, PT
• Chuck R Colas, DO
• Misti Collins, LMSW
• Tracy Ann Collins, ATC, LAT

• Ophthalmology Physician in Lewiston, ID
• Providers in Lewiston, ID by specialty
• Ophthalmology Physician in Idaho

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 23, 2007; 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.