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Organization

MADISON CLINIC OPTOMETRY, P.C.

Active
Organization subpart
No

Provider details

NPI number
Authorized official
DR. DALLIN HEINER O.D. (PRESIDENT)
(208) 359-1880
Entity
Organization

Contact information

Practice address
244 E MAIN ST, REXBURG, ID 83440-2022
(208) 359-1880
(208) 359-2025
Mailing address
244 E MAIN ST, REXBURG, ID 83440-2022
(208) 359-1880
(208) 359-2025

Taxonomy

Speciality
Code
Description
License number
State
152W00000X
Optometrist
Primary

Other

Other identifiers
Code
Description
Identifier
Issuer
State
01
000010149064
REGENCE BLUE SHIELD OF ID
ID
01
V6499
BLUE CROSS
ID
Enumeration date
08/31/2006
Last updated
11/28/2007
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