Family Eye Care of Orofino, P.a.
Organization Active NPI Optometrist · Orofino, ID
NPI 1629210331 · NPPES record last updated Jan 19, 2011
Key facts
- NPI
- 1629210331
- Entity type
- Organization (NPI type 2)
- Primary specialty
- Optometrist 152W00000X
- License
- ODP-729 (ID)
- Legal business name
- FAMILY EYE CARE OF OROFINO, P.A.
- Practice address
- 180 Michigan Ave.
Orofino, ID 83544-9066 - Phone
- (208) 476-4814
- Fax
- (208) 476-3921
- NPI assigned
- Mar 26, 2009
- Organization subpart
- No
Authorized official
- Name
- Dr. Rick G. Lundgren, O.D.
- Title
- President
- Phone
- (208) 476-4814
Practitioners 2
-
Rick G Lundgren, O.D.
-
Jolene Marie McManus, B.A.
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in ID
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| O20090519000278 | ID | Part B Supplier - Clinic/Group Practice | 8325197544 |
Receives reassigned benefits from 1 practitioner Practice locations: Orofino, ID |
National Provider Directory
Locations
180 Michigan Ave
Orofino, ID 83544
Phone (208) 476-3921
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Optometrist |
152W00000X | ODP-729 | ID | Yes |
Addresses
Primary practice location
180 Michigan Ave.
Orofino, ID 83544-9066
Mailing address
PO Box 147
Orofino, ID 83544-0147
Phone (208) 476-4814
Other names
- Family Eye Care
Other providers in Orofino, ID
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Jan 19, 2011. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.