Healthcare Provider Details

I. General information

NPI: 1174269476
Provider Name (Legal Business Name): ALEXANDER DURRANT
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/10/2022
Last Update Date: 05/14/2026
Certification Date: 05/14/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1605 BLUE LAKES BLVD N STE A
TWIN FALLS ID
83301-3322
US

IV. Provider business mailing address

3485 N COLE RD UNIT 45479
BOISE ID
83711-1095
US

V. Phone/Fax

Practice location:
  • Phone: 208-417-1020
  • Fax:
Mailing address:
  • Phone: 833-776-2020
  • Fax: 208-736-5312

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code152W00000X
TaxonomyOptometrist
License NumberODP-100573
License Number StateID
# 2
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: