Individual
DR. RYAN E NIELSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
OD
Contact information
Practice address
1715 S WELLS AVE, MERIDIAN, ID 83642-5756
(208) 898-0304
(208) 898-0380
Mailing address
2320 E GALA ST, SUITE 400, MERIDIAN, ID 83642-7091
(208) 898-0304
Taxonomy
Speciality
Code
Description
License number
State
152W00000X
Optometrist
Primary
ODP-100015
ID
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
000010139527
BLUE SHIELD OF IDAHO
ID
05
—
806418900
—
ID
05
—
806418901
—
ID
01
—
V6945
BLUE CROSS GROUP #
ID
01
—
V6952
BLUE CROSS IDAHO
ID
Enumeration date
06/15/2006
Last updated
09/10/2024
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