Individual
DR. TREVOR H DICKSON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
OD
Contact information
Practice address
500 S UTAH AVE, IDAHO FALLS, ID 83402-3305
(208) 709-5371
Mailing address
500 S UTAH AVE, IDAHO FALLS, ID 83402-3305
(208) 709-5371
Taxonomy
Speciality
Code
Description
License number
State
152W00000X
Optometrist
Primary
100510
ID
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
100510
IDAHO OPTOMETRY LICENSE
ID
Enumeration date
06/19/2020
Last updated
06/19/2020
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