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General NPI Number Information
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NPI Number | 1407984925
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Entity Type | Organization
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Legal Business Name | DREW C DAYTON CHARTERED
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Dates
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Enumeration Date | 02/28/2007
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Last Update Date | 02/24/2012
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Provider Practice Location Address
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Address Line | 622 E. MAIN ST.
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City | MIDDLETON
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State | ID
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Zip | 83644-5502
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Country | US
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Telephone | 208-585-9500
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Fax | 208-585-9497
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Provider Business Mailing Address
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Address Line | 622 E. MAIN ST.
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City | MIDDLETON
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State | ID
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Zip | 83644-5502
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Country | US
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Telephone | 208-585-9500
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Fax | 208-585-9497
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Authorized Official
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Title or Position | PRESIDENT OWNER
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Name | DREW C DAYTON
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Credential | O.D.
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Telephone | 208-585-9500
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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-823
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License Number State | ID
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