Individual
DR. DANIEL GLENN NIELSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
OD
Contact information
Practice address
1536 MIDWAY DR, AMMON, ID 83406-6912
(208) 227-8822
Mailing address
1536 MIDWAY DR, AMMON, ID 83406-6912
(662) 622-1401
Taxonomy
Speciality
Code
Description
License number
State
152W00000X
Optometrist
Primary
ODP100434
ID
152WC0802X
Corneal and Contact Management Optometrist
ODP100434
ID
152WL0500X
Low Vision Rehabilitation Optometrist
ODP100434
ID
152WP0200X
Pediatric Optometrist
ODP100434
ID
152WS0006X
Sports Vision Optometrist
ODP100434
ID
152WV0400X
Vision Therapy Optometrist
ODP100434
ID
Other
Enumeration date
06/18/2017
Last updated
07/06/2019
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