Individual
DR. BRYCE BYRAM THUESON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
O.D.
Contact information
Practice address
76 PROFESSIONAL PLZ, REXBURG, ID 83440-2047
(208) 356-4585
(208) 356-4587
Mailing address
76 PROFESSIONAL PLZ, REXBURG, ID 83440-2047
(208) 356-4585
(208) 356-4587
Taxonomy
Speciality
Code
Description
License number
State
152W00000X
Optometrist
Primary
ODP-100014
ID
152WC0802X
Corneal and Contact Management Optometrist
ODP-100014
ID
152WL0500X
Low Vision Rehabilitation Optometrist
ODP-100014
ID
152WP0200X
Pediatric Optometrist
ODP-100014
ID
152WS0006X
Sports Vision Optometrist
ODP-100014
ID
152WV0400X
Vision Therapy Optometrist
ODP-100014
ID
152WX0102X
Occupational Vision Optometrist
ODP-100014
ID
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
000010146982
BLUE SHIELD
ID
05
—
807155800
—
ID
01
—
ODP-100014
IDAHO OPTOMETRY LICENSE
ID
01
—
V631-7
BLUE CROSS
ID
Enumeration date
06/08/2006
Last updated
07/22/2010
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