Individual
DR. JOHN C WEISEL
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
O.D.
Contact information
Practice address
1814 LINCOLN WAY, COEUR D ALENE, ID 83814-2540
(208) 667-2531
(208) 765-9385
Mailing address
1814 LINCOLN WAY, COEUR D ALENE, ID 83814-2540
(208) 667-2531
(208) 765-9385
Taxonomy
Speciality
Code
Description
License number
State
152W00000X
Optometrist
Primary
ODP970
ID
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
000010015493
REGENCE BLUE SHIELD OF ID
ID
01
—
1592883
MEDICARE
ID
01
—
1592894
MEDICARE GROUP
ID
05
—
804004300
—
ID
01
—
V9709
BLUE CROSS OF IDAHO
HI
Enumeration date
01/29/2007
Last updated
07/06/2010
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