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General NPI Number Information
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NPI Number | 1457461261
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Entity Type | Individual
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Provider Name | DENNIS RADFORD O.D.
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Gender | Male
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Dates
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Enumeration Date | 08/30/2006
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Last Update Date | 11/14/2025
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Provider Practice Location Address
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Address Line | 357 W FIR ST
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City | SHELLEY
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State | ID
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Zip | 83274-1456
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Country | US
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Telephone | 208-881-5145
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Fax | 208-881-5146
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Provider Business Mailing Address
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Address Line | PO BOX K
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City | SHELLEY
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State | ID
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Zip | 83274-0910
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Country | US
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Telephone | 208-881-5145
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Fax | 208-881-5146
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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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-100115
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License Number State | ID
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