Organization
STEVEN G IWASA OD PLLC
Active
Other names
Weiser Vision Clinic
Organization subpart
No
Provider details
NPI number
Authorized official
DR. STEVEN G IWASA OD (OPTOMETRIST)
(208) 414-1600
Entity
Organization
Contact information
Practice address
36 W COURT ST, WEISER, ID 83672-1941
(208) 414-1600
(208) 414-1607
Mailing address
36 W COURT ST, WEISER, ID 83672-1941
(208) 414-1600
(208) 414-1607
Taxonomy
Speciality
Code
Description
License number
State
152W00000X
Optometrist
Primary
ODD649
ID
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
000010137310
BLUE SHIELD
—
05
—
0008449
—
ID
01
—
814368000
BLUE CROSS / BLUE SHIELD
—
01
—
P00102776
RR MEDICARE
—
01
—
V4999
BLUE CROSS
—
Enumeration date
01/09/2012
Last updated
01/09/2012
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