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NPI Code Detail

MEDICARE: DR. LARRY V. DOWNER O.D.

MEDICARE: DR. LARRY V. DOWNER O.D.
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1152W00000XOptometristODP456ID

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1000010015206OTHERIDREGENCE BLUE SHIELD
234870OTHERIDDAVIS VISION
3V024 5OTHERIDBLUE CROSS

General Provider Information

NPI Number : 1891798773
Entity Type Code : Individual
Provider Name (Legal Business Name) : DR. LARRY V. DOWNER O.D.
Provider Business Mailing Address
First Line : 1016 E LOCUST ST
Second Line :
City : EMMETT
State : ID
Zip : 83617-2776
Country : US
Telephone Number : 208-365-3584
Fax Number : 208-365-2471
Provider Business Practice Location Address
First Line : 1016 E LOCUST ST
Second Line :
City : EMMETT
State : ID
Zip : 83617-2776
Country : US
Telephone Number : 208-365-3584
Fax Number : 208-365-2471
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 05/24/2005
Last Update Date : 01/31/2008

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Directions to “ DR. LARRY V. DOWNER O.D.” Practice Location

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