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Contact Information

WENDELL FACKRELL, OD
421 N. COLE RD. STE 102
BOISE, ID83704
 Phone: 208-658-1068
 Fax:
 Website:
 

Specialty

Taxonomy Code Specialty Code Provider Type

Optometrist

152W00000X 41 Optometry
Indicates primary specialty

NPI Profile & details for WENDELL FACKRELL · (Male)

NPI # 1750678298
Status Active
Credentials OD (Doctor of Optometry)
Entity Individual
Enumeration date 07/05/2011
Last updated 08/06/2016 - About 10 years ago
Sole proprietor 1 Yes
Identifiers
  • ID License # ODP-100232
Hospital affiliation(s) Not Available
1 A sole proprietor/sole proprietorship is an individual, and as such, is eligible for a single NPI number. The sole proprietor must apply for the NPI number using his or her own Social Security Number (SSN), not an Employer Identification Number (EIN) even if he/she has an EIN.

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