Individual
DR. CHAD WILLIAM CLEVERLY
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
O.D.
Contact information
Practice address
3293 N MILWAUKEE ST, BOISE, ID 83704-4446
(208) 322-2020
(208) 322-1192
Mailing address
3293 N MILWAUKEE ST, BOISE, ID 83704-4446
(208) 322-2020
(208) 322-1192
Taxonomy
Speciality
Code
Description
License number
State
152W00000X
Optometrist
Primary
ODP-1015
ID
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
000010015598
BLUE SHIELD
ID
01
—
0198230001
CIGNA SUPPLIER
ID
01
—
V3967
BLUE CROSS
ID
Enumeration date
07/15/2006
Last updated
07/08/2007
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