Provider Demographics
NPI:1528103967
Name:ZENGOE, CLARE T (OD)
Entity type:Individual
Prefix:DR
First Name:CLARE
Middle Name:T
Last Name:ZENGOE
Suffix:
Gender:F
Credentials:OD
Other - Prefix:
Other - First Name:
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Mailing Address - Street 1:303 NECTARINE ST
Mailing Address - Street 2:
Mailing Address - City:NAMPA
Mailing Address - State:ID
Mailing Address - Zip Code:83686
Mailing Address - Country:US
Mailing Address - Phone:208-376-1346
Mailing Address - Fax:208-376-1367
Practice Address - Street 1:12598 FAIRVIEW AVE
Practice Address - Street 2:SUITE 103
Practice Address - City:BOISE
Practice Address - State:ID
Practice Address - Zip Code:83713-0026
Practice Address - Country:US
Practice Address - Phone:208-376-1346
Practice Address - Fax:208-376-1367
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-21
Last Update Date:2010-02-05
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
IDODP0925152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist