| Hollingshead Eye Center, Pc | |
|
360 E Mallard Dr, Suite 110, Boise, ID 83706-6644 | |
| (208) 336-8700 | |
| (208) 426-0902 |
| Full Name | Hollingshead Eye Center, Pc |
|---|---|
| Type | Facility |
| Speciality | Ophthalmology |
| Location | 360 E Mallard Dr, Boise, Idaho |
| Accepts Medicare Assignments | Medicare enrolled and accepts medicare insurance. Providers at this facility may prescribe medicare part D drugs. |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1871643585 | NPI | - | NPPES |
| 805858400 | Medicaid | ID | |
| 805858500 | Medicaid | ID |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 152W00000X | Optometrist | ODP100159 (Idaho) | Secondary |
| 207W00000X | Ophthalmology | M6436 (Idaho) | Primary |
| Provider Name | Mark E Hollingshead |
|---|---|
| Provider Type | Practitioner - Ophthalmology |
| Provider Identifiers | NPI Number: 1689670911 PECOS PAC ID: 4789628165 Enrollment ID: I20101222001004 |
| Provider Name | Dylan Leon Hatfield |
|---|---|
| Provider Type | Practitioner - Optometry |
| Provider Identifiers | NPI Number: 1972813855 PECOS PAC ID: 2567779986 Enrollment ID: I20150917001991 |
| Provider Name | Kacey D Blaylock |
|---|---|
| Provider Type | Practitioner - Optometry |
| Provider Identifiers | NPI Number: 1164871489 PECOS PAC ID: 2062705460 Enrollment ID: I20160722000745 |
| Provider Name | Ryan Barrett |
|---|---|
| Provider Type | Practitioner - Ophthalmology |
| Provider Identifiers | NPI Number: 1982994844 PECOS PAC ID: 9931420452 Enrollment ID: I20160912001778 |
| Provider Name | Scott A Woolf |
|---|---|
| Provider Type | Practitioner - Ophthalmology |
| Provider Identifiers | NPI Number: 1629509682 PECOS PAC ID: 3274913702 Enrollment ID: I20220630001040 |
| Mailing Address | Practice Location Address |
|---|---|
| Hollingshead Eye Center, Pc 360 E Mallard Dr, Suite 110, Boise, ID 83706-6644 Ph: (208) 336-8700 | Hollingshead Eye Center, Pc 360 E Mallard Dr, Suite 110, Boise, ID 83706-6644 Ph: (208) 336-8700 |