Organization
DAVID M. WARD, JR., OD, PA
Active
Other names
Vision Specialties, Vision Source Boise
Organization subpart
No
Provider details
NPI number
Authorized official
DR. CHAD H CLARK O.D. (OWNER/DOCTOR)
(208) 322-8381
Entity
Organization
Contact information
Practice address
1205 S FIVE MILE RD, BOISE, ID 83709-1304
(208) 322-8381
Mailing address
1205 S FIVE MILE RD, BOISE, ID 83709-1304
(208) 322-8381
Taxonomy
Speciality
Code
Description
License number
State
152W00000X
Optometrist
ODP-682
ID
152W00000X
Optometrist
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
000010015463
BLUE SHIELD
ID
01
—
6055070001
PTAN
—
05
—
806420300
—
ID
01
—
V5269
BLUE CROSS OF IDAHO
ID
Enumeration date
12/11/2006
Last updated
10/07/2021
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