David John Antonie, O.D.
Individual provider Active NPI Optometrist · Boise, ID
NPI 1215071246 · NPPES record last updated Jul 8, 2007
Key facts
- NPI
- 1215071246
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Optometrist 152W00000X
- License
- ODP 896 (ID)
- 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
- Sex
- Male
- Sole proprietor
- Yes
Organizations & group practices 1
Medicare participation
- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
- Medicare enrollment (NPD)
- No
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 |
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Optometrist | 152W00000X | ODP 896 | ID | Yes |
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
Other providers in Boise, ID
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Jul 8, 2007. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.