Individual
DR. OWEN M SHIRTS
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
O.D.
Contact information
Practice address
838 S WOODRUFF AVE, IDAHO FALLS, ID 83401-5296
(208) 523-3937
(208) 523-4251
Mailing address
838 S WOODRUFF AVE, IDAHO FALLS, ID 83401-5296
(208) 523-3937
(208) 523-4251
Taxonomy
Speciality
Code
Description
License number
State
152W00000X
Optometrist
Primary
ODP716
ID
152WC0802X
Corneal and Contact Management Optometrist
ODP716
ID
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
000010015228
BLUE SHIELD
ID
05
—
002609700
—
ID
01
—
410041059
MEDICARE RAILROAD
ID
01
—
CS9984
CONTROLLED SUBSTANCE
ID
01
—
V7269
BLUE CROSS
ID
Enumeration date
12/07/2006
Last updated
03/07/2023
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