Individual
DR. DAN C. THIEME
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
O.D.
Contact information
Practice address
1648 NW 2ND ST, MERIDIAN, ID 83642-2224
(208) 888-2200
(208) 888-7623
Mailing address
1648 NW 2ND ST, MERIDIAN, ID 83642-2224
(208) 888-2200
(208) 888-7623
Taxonomy
Speciality
Code
Description
License number
State
152W00000X
Optometrist
Primary
ODP-901
ID
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
000010015459
BLUE SHIELD #
ID
05
—
001519300
—
ID
01
—
V902-2
BLUE CROSS
ID
Enumeration date
08/14/2006
Last updated
05/02/2019
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