Individual
DR. DENNIS EARL NIELSON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
O.D.
Contact information
Practice address
1012 N MAIN ST, MERIDIAN, ID 83642-2304
(208) 888-5252
Mailing address
2804 S GOSHEN WAY, BOISE, ID 83709-8570
(208) 322-6161
Taxonomy
Speciality
Code
Description
License number
State
152W00000X
Optometrist
Primary
ODP-498
ID
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
0644950001
DMERC
ID
01
—
15254
BLUE SHIELD
ID
01
—
V7310
BLUE CROSS
ID
Enumeration date
01/05/2007
Last updated
10/17/2007
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