Individual
DR. DANIEL L TILLER
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
O.D.
Contact information
Practice address
901 12TH AVE S, NAMPA, ID 83651-4658
(208) 466-9251
(208) 463-1714
Mailing address
901 12TH AVE S, NAMPA, ID 83651-4658
(208) 466-9251
(208) 463-1714
Taxonomy
Speciality
Code
Description
License number
State
152W00000X
Optometrist
Primary
ODP-696
ID
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
000010015295
REGENCEY OF IDAHO
ID
05
—
807007400
—
ID
01
—
V5475
BLUE CROSS OF ID
ID
Enumeration date
08/24/2005
Last updated
03/10/2010
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