Individual
DR. DWIGHT HANSEN
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
O.D.
Contact information
Practice address
225 W MAIN ST, RIGBY, ID 83442-1351
(208) 745-8773
Mailing address
225 W MAIN ST, RIGBY, ID 83442-1351
(208) 745-8773
Taxonomy
Speciality
Code
Description
License number
State
152W00000X
Optometrist
Primary
ODP-747
ID
152WC0802X
Corneal and Contact Management Optometrist
ODP-747
ID
152WL0500X
Low Vision Rehabilitation Optometrist
ODP-747
ID
152WP0200X
Pediatric Optometrist
ODP-747
ID
152WX0102X
Occupational Vision Optometrist
ODP-747
ID
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
002382900
—
ID
01
—
410015645
RR MEDICARE
ID
Enumeration date
08/11/2006
Last updated
02/10/2012
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