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Organization

DAN C. THIEME O.D., P.C

Active
Organization subpart
No

Provider details

NPI number
Authorized official
DR. DAN C. THIEME O.D. (OWNER)
(208) 888-2200
Entity
Organization

Contact information

Practice address
1648 W 2ND ST, MERIDIAN, ID 83642-2224
(208) 888-2200
(208) 888-7623
Mailing address
1648 W 2ND ST, MERIDIAN, ID 83642-2224
(208) 888-2200
(208) 888-7623

Taxonomy

Speciality
Code
Description
License number
State
152W00000X
Optometrist
Primary
0-901
ID

Other

Other identifiers
Code
Description
Identifier
Issuer
State
01
000010015459
BLUE SHIELD
ID
05
001519300
ID
01
T1560526754529
VSP MEMBER NUMBER
ID
01
V902-2
BLUE CROSS
ID
Enumeration date
08/15/2006
Last updated
08/06/2010
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