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PEND OREILLE VISION CARE

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Company Details

Name: PEND OREILLE VISION CARE
Jurisdiction: Idaho
Legal type: Assumed Business Name
Status: Active-Current
Date of registration: 01 Jul 2010 (15 years ago)
Entity Number: 428250
Place of Formation: IDAHO
File Number: 0000428250
Mailing Address: STE A 514 OAK ST SANDPOINT, ID 83864-1480

National Provider Identifier

NPI Number:
1104316785
Certification Date:
2023-03-09

Authorized Person:

Name:
DR. NATHANEAL HARRELL
Role:
OWNER/PRESIDENT
Phone:

Taxonomy:

Selected Taxonomy:
261Q00000X - Clinic/Center
Is Primary:
No
Selected Taxonomy:
152W00000X - Optometrist
Is Primary:
Yes

Contacts:

Fax:
2082657905
Fax:
2084480147

Filing

Filing Name Filing Number Filing date
Amendment of Certificate of Assumed Business Name 0003768256 2020-02-10
Initial Filing 0000428250 2010-07-01

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Date of last update: 25 Sep 2024

Sources: Idaho Secretary of State