Individual
JAIMEN L. DIXON
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
O.D.
Contact information
Practice address
700 N RAYMOND ST, BOISE, ID 83704-9261
(208) 375-3871
(406) 222-8419
Mailing address
700 N RAYMOND ST, BOISE, ID 83704-9261
(208) 375-3871
(406) 222-8419
Taxonomy
Speciality
Code
Description
License number
State
152W00000X
Optometrist
Primary
ODP-100399
ID
152WC0802X
Corneal and Contact Management Optometrist
ODP-100399
ID
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1861841033
—
ID
Enumeration date
06/08/2016
Last updated
08/04/2023
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