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General NPI Number Information
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NPI Number | 1760504237
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Entity Type | Individual
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Provider Name | ISAIAH AUSTIN O.D.
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Gender | Male
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Dates
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Enumeration Date | 04/04/2007
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Last Update Date | 07/08/2007
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Provider Practice Location Address
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Address Line | 731 POLELINE RD
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City | TWIN FALLS
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State | ID
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Zip | 83301-3036
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Country | US
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Telephone | 208-732-5688
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Fax | 208-736-1596
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Provider Business Mailing Address
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Address Line | 217 BUCHANAN ST
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City | TWIN FALLS
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State | ID
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Zip | 83301-5242
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Country | US
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Telephone | 208-948-5551
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Fax | 208-736-1596
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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 | ODP100082
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License Number State | ID
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