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General NPI Number Information
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NPI Number | 1346383957
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Entity Type | Organization
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Legal Business Name | IWASA EYE CENTER P.A.
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Dates
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Enumeration Date | 02/14/2007
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Last Update Date | 07/11/2023
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Provider Practice Location Address
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Address Line | 925 NW 12TH ST
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City | FRUITLAND
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State | ID
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Zip | 83619-5044
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Country | US
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Telephone | 208-642-2151
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Fax | 208-452-6508
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Provider Business Mailing Address
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Address Line | 925 NW 12TH ST
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City | FRUITLAND
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State | ID
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Zip | 83619-5044
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Country | US
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Telephone | 208-452-2151
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Fax | 208-452-6508
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Authorized Official
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Title or Position | OPTOMETHRIC PHYSICIAN
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Name | DR. DANIEL E. IWASA
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Credential | O.D.
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Telephone | 208-452-2151
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 152W00000X
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Taxonomy Name | Optometrist
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License Number | ODP-856
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License Number State | ID
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