Healthcare Provider Details

I. General information

NPI: 1962441303
Provider Name (Legal Business Name): DANIEL RICHARD BOESPFLUG O.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/04/2006
Last Update Date: 06/02/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3293 N MILWAUKEE ST
BOISE ID
83704-4446
US

IV. Provider business mailing address

3293 N MILWAUKEE ST
BOISE ID
83704-4446
US

V. Phone/Fax

Practice location:
  • Phone: 208-322-2020
  • Fax: 208-322-1192
Mailing address:
  • Phone: 208-322-2020
  • Fax: 208-322-1192

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code152W00000X
TaxonomyOptometrist
License Number0-683
License Number StateID
# 2
Primary TaxonomyN
Taxonomy Code152WC0802X
TaxonomyCorneal and Contact Management Optometrist
License Number0-683
License Number StateID

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: