Individual
DR. NATHAN G KOHLER
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
O.D.
Contact information
Practice address
320 S WOODRUFF AVE, IDAHO FALLS, ID 83401-4329
(208) 524-4552
(208) 524-4559
Mailing address
320 S WOODRUFF AVE, IDAHO FALLS, ID 83401-4329
(208) 524-4552
(208) 524-4559
Taxonomy
Speciality
Code
Description
License number
State
152W00000X
Optometrist
Primary
ODP100034
ID
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
000010144177
BLUE SHIELD
ID
01
—
00034
VBA
ID
01
—
21776
SPECTERA
ID
05
—
806671900
—
ID
01
—
V5996
BLUE CROSS INDIVIDUAL
ID
Enumeration date
07/10/2007
Last updated
07/21/2007
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