Provider Demographics
NPI:1851476493
Name:POST FALLS VISION CLINIC PLLC
Entity type:Organization
Organization Name:POST FALLS VISION CLINIC PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OPTOMETRIST/OWNER
Authorized Official - Prefix:
Authorized Official - First Name:ELWIN
Authorized Official - Middle Name:W
Authorized Official - Last Name:SCHUTT
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:208-773-7434
Mailing Address - Street 1:2525 E SELTICE WAY
Mailing Address - Street 2:PO BOX 997
Mailing Address - City:POST FALLS
Mailing Address - State:ID
Mailing Address - Zip Code:83854-5089
Mailing Address - Country:US
Mailing Address - Phone:208-773-7434
Mailing Address - Fax:208-777-0836
Practice Address - Street 1:2525 E SELTICE WAY
Practice Address - Street 2:
Practice Address - City:POST FALLS
Practice Address - State:ID
Practice Address - Zip Code:83854-5089
Practice Address - Country:US
Practice Address - Phone:208-773-7434
Practice Address - Fax:208-777-0836
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-25
Last Update Date:2007-08-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IDODP-499152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IDV7321OtherBLUE CROSS OF IDAHO
ID0430240001OtherMEDICARE DMERC
ID1590721Medicare PIN