Individual
DR. PAUL D WHITESIDES
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
O.D.
Contact information
Practice address
999 N CURTIS RD, # 205, BOISE, ID 83706-9999
(208) 373-1200
(208) 373-1216
Mailing address
999 N CURTIS RD, # 205, BOISE, ID 83706-9999
(208) 373-1200
(208) 373-1216
Taxonomy
Speciality
Code
Description
License number
State
152W00000X
Optometrist
Primary
ODP473
ID
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
000010015330
REGENCE BLUE SHIELD OF ID
ID
01
—
V4734
BLUE CROSS OF IDAHO
ID
Enumeration date
10/04/2006
Last updated
08/22/2007
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