Individual
BRUCE SLAVIN
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
O.D.
Contact information
Practice address
818 MAIN ST, STE E, SALMON, ID 83467-4350
(208) 756-3600
(208) 756-3772
Mailing address
818 MAIN ST, STE E, SALMON, ID 83467-4350
(208) 756-3600
(208) 756-3772
Taxonomy
Speciality
Code
Description
License number
State
152W00000X
Optometrist
Primary
ODP-0836
ID
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
000010015348
BLUE SHIELD IDAHO
ID
01
—
0587110001
DMERC
ID
01
—
V7268
BLUE CROSS IDAHO
ID
Enumeration date
03/20/2007
Last updated
07/08/2007
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