Individual
DR. LARRY D BREAZEAL
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
O.D.
Contact information
Practice address
8220 N CORNERSTONE DR STE A, HAYDEN, ID 83835-8683
(208) 772-5539
(208) 772-9382
Mailing address
8220 N CORNERSTONE DR STE A, HAYDEN, ID 83835-8683
(208) 659-9912
(208) 772-9382
Taxonomy
Speciality
Code
Description
License number
State
152W00000X
Optometrist
OD00003957
WA
152W00000X
Optometrist
Primary
ODP-1014
ID
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
2029890
—
WA
05
—
805604301
—
ID
Enumeration date
11/15/2006
Last updated
03/17/2025
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