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General NPI Number Information
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NPI Number | 1780790154
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Entity Type | Organization
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Legal Business Name | DAN C THIEME OD PC
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Dates
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Enumeration Date | 08/21/2006
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Last Update Date | 12/11/2008
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Provider Practice Location Address
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Address Line | 827 CENTER AVE
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City | PAYETTE
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State | ID
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Zip | 83661-2535
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Country | US
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Telephone | 208-642-4434
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Fax | 208-642-1433
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Provider Business Mailing Address
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Address Line | 827 CENTER AVE
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City | PAYETTE
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State | ID
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Zip | 83661-2535
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Country | US
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Telephone | 208-642-4434
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Fax | 208-642-1433
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Authorized Official
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Title or Position | OWNER
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Name | DR. DAN C. THIEME
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Credential | O.D.
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Telephone | 208-642-4434
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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 | 0-901
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License Number State | ID
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