Active NPI
Nathan Lee Anderson, O.D.
- Optometrist
- Mountain Home Afb, ID
National Provider Identifier
1285610444
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Optometrist
- License
- ODP-100562
- Practice address
- 90 Hope Dr BLDG 6000
Mountain Home Afb, ID 83648-1062 - Phone
- (208) 828-7250
- NPI assigned
- Dec 20, 2005
- Sex
- Male
- Sole proprietor
- No
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-100562 | ID | Primary |
Addresses
Primary practice location
90 Hope Dr BLDG 6000
Mountain Home Afb, ID 83648-1062
Mailing address
90 Hope Dr BLDG 6000
Mountain Home Afb, ID 83648-1062
Phone (208) 828-7250
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-100562 | ID | MD | Optometrist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1135036800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1652918400000",
"number": "1285610444",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "90 HOPE DR BLDG 6000",
"city": "MOUNTAIN HOME AFB",
"state": "ID",
"postal_code": "836481062",
"telephone_number": "208-828-7250"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "90 HOPE DR BLDG 6000",
"city": "MOUNTAIN HOME AFB",
"state": "ID",
"postal_code": "836481062",
"telephone_number": "208-828-7250"
}
],
"practiceLocations": [],
"basic": {
"last_name": "ANDERSON",
"first_name": "NATHAN",
"middle_name": "LEE",
"name_prefix": "Dr.",
"credential": "O.D.",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2005-12-20",
"last_updated": "2022-05-19",
"certification_date": "2022-05-19",
"status": "A"
},
"taxonomies": [
{
"code": "152W00000X",
"taxonomy_group": "",
"desc": "Optometrist",
"state": "ID",
"license": "ODP-100562",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Mountain Home Afb, ID
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 19, 2022; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.