Active NPI
Donald L Bader, OD
- Optometrist
- Nampa, ID
National Provider Identifier
1407051733
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Optometrist
- License
- 0-920
- Practice address
- 2025 12TH Ave Rd
Nampa, ID 83686-6459 - Phone
- (208) 461-1000
- NPI assigned
- Jun 18, 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 | 0-920 | ID | Primary |
Addresses
Primary practice location
2025 12TH Ave Rd
Nampa, ID 83686-6459
Mailing address
2025 12TH Ave Rd
Nampa, ID 83686-6459
Phone (208) 461-1000
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 |
|---|---|---|---|
| 0-920 | ID | MD | Optometrist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1182124800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1183852800000",
"number": "1407051733",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "2025 12TH AVE RD",
"city": "NAMPA",
"state": "ID",
"postal_code": "836866459",
"telephone_number": "208-461-1000"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "2025 12TH AVE RD",
"city": "NAMPA",
"state": "ID",
"postal_code": "836866459",
"telephone_number": "208-461-1000"
}
],
"practiceLocations": [],
"basic": {
"last_name": "BADER",
"first_name": "DONALD",
"middle_name": "L",
"name_prefix": "Dr.",
"credential": "OD",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2007-06-18",
"last_updated": "2007-07-08",
"status": "A"
},
"taxonomies": [
{
"code": "152W00000X",
"taxonomy_group": "",
"desc": "Optometrist",
"state": "ID",
"license": "0-920",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Nampa, 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.