Organization
DR MARK D DENNEY OD PA
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MARK D DENNEY OD (OPTOMETRIST)
(208) 523-3141
Entity
Organization
Contact information
Practice address
1340 S. AMMON ROAD, IDAHO FALLS, ID 83406
(208) 523-3141
(208) 525-2661
Mailing address
1340 S AMMON RD, AMMON, ID 83406-5810
(208) 523-3141
(208) 525-2661
Taxonomy
Speciality
Code
Description
License number
State
152W00000X
Optometrist
Primary
ODP1012
ID
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
000010026621
BLUE SHIELD
ID
01
—
167539
COLE
ID
05
—
805561900
—
ID
01
—
V3918
BLUE CROSS
ID
Enumeration date
05/15/2007
Last updated
06/21/2018
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