Active NPI
David John Antonie, O.D.
- Optometrist
- Boise, ID
National Provider Identifier
1215071246
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Optometrist
- License
- ODP 896
- Practice address
- 460 N Milwaukee St
Sears Optical
Boise, ID 83704-9122 - Phone
- (208) 375-3030
- Fax
- (208) 375-3030
- NPI assigned
- Feb 15, 2007
- Last updated
- Jul 8, 2007
- Sex
- Male
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Optometrist | 152W00000X | ODP 896 | ID | Primary |
Addresses
Primary practice location
460 N Milwaukee St
Sears Optical
Boise, ID 83704-9122
Mailing address
2593 N Devlin Ave
Meridian, ID 83642-7313
Phone (208) 863-5409
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)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| ODP 896 | ID | MD | Optometrist |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Luxottica of America Inc | Past | Accepting new patients |
Organizations & group practices 1
Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1171497600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1183852800000",
"number": "1215071246",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "2593 N DEVLIN AVE",
"city": "MERIDIAN",
"state": "ID",
"postal_code": "836427313",
"telephone_number": "208-863-5409"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "460 N MILWAUKEE ST",
"address_2": "SEARS OPTICAL",
"city": "BOISE",
"state": "ID",
"postal_code": "837049122",
"telephone_number": "208-375-3030",
"fax_number": "208-375-3030"
}
],
"practiceLocations": [],
"basic": {
"last_name": "ANTONIE",
"first_name": "DAVID",
"middle_name": "JOHN",
"name_prefix": "Dr.",
"credential": "O.D.",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2007-02-15",
"last_updated": "2007-07-08",
"status": "A"
},
"taxonomies": [
{
"code": "152W00000X",
"taxonomy_group": "",
"desc": "Optometrist",
"state": "ID",
"license": "ODP 896",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Boise, ID
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 8, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.