Individual provider Active NPI

David Anton Wold, M.D.

  • Ophthalmology Physician
  • Coeur D Alene, ID
National Provider Identifier
1194861278
Registry record updated Jul 6, 2010
On this page

Key facts

NPPES NPI Registry
Primary specialty
Ophthalmology PhysicianTaxonomy code 207W00000X
License
M3141 Issued in ID
Practice address
1814 Lincoln Way
Coeur D Alene, ID 83814-2540
Phone
(208) 667-2531
Fax
(208) 765-9385
NPI assigned
Jan 29, 2007
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jul 6, 2010

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Ophthalmology Physician 207W00000X M3141 ID Primary

Addresses

Primary practice location

1814 Lincoln Way
Coeur D Alene, ID 83814-2540

Mailing address

1814 Lincoln Way
Coeur D Alene, ID 83814-2540
Phone (208) 667-2531

Other identifiers 4

IdentifierTypeStateIssuer
004011500MedicaidID
1518003516OtherNORTH IDAHO CATARACT & LA
000010006141OtherIDREGENCE BLUE SHIELD OF ID
31419OtherIDBLUE CROSS OF IDAHO

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Not listed in the public Medicare enrollment file

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Doctor of Medicine

State licenses

LicenseStateTypeSpecialty
M3141IDMDOphthalmology Physician

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1170028800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1278374400000",
    "number": "1194861278",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1814 LINCOLN WAY",
            "city": "COEUR D ALENE",
            "state": "ID",
            "postal_code": "838142540",
            "telephone_number": "208-667-2531",
            "fax_number": "208-765-9385"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1814 LINCOLN WAY",
            "city": "COEUR D ALENE",
            "state": "ID",
            "postal_code": "838142540",
            "telephone_number": "208-667-2531",
            "fax_number": "208-765-9385"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "WOLD",
        "first_name": "DAVID",
        "middle_name": "ANTON",
        "name_prefix": "Dr.",
        "credential": "M.D.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2007-01-29",
        "last_updated": "2010-07-06",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207W00000X",
            "taxonomy_group": "",
            "desc": "Ophthalmology",
            "state": "ID",
            "license": "M3141",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "004011500",
            "state": "ID"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "NORTH IDAHO CATARACT & LA",
            "identifier": "1518003516",
            "state": null
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "REGENCE BLUE SHIELD OF ID",
            "identifier": "000010006141",
            "state": "ID"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BLUE CROSS OF IDAHO",
            "identifier": "31419",
            "state": "ID"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Coeur D Alene, ID

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 6, 2010; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.