Organization
DAN C THIEME OD PC
Active
Other names
Payette Family Eyecare
Organization subpart
No
Provider details
NPI number
Authorized official
DR. DAN C. THIEME O.D. (OWNER)
(208) 642-4434
Entity
Organization
Contact information
Practice address
827 CENTER AVE, PAYETTE, ID 83661-2535
(208) 642-4434
(208) 642-1433
Mailing address
827 CENTER AVE, PAYETTE, ID 83661-2535
(208) 642-4434
(208) 642-1433
Taxonomy
Speciality
Code
Description
License number
State
152W00000X
Optometrist
Primary
0-901
ID
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
000010015223
BLUE SHIELD
ID
05
—
001519301
—
ID
01
—
V6002
BLUE CROSS
ID
Enumeration date
08/21/2006
Last updated
12/11/2008
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