NPIMap

Organization Active NPI

Dallas Stevens OD PA

  • Optometrist
  • Boise, ID
National Provider Identifier
1477053007
Registry record updated Feb 20, 2018
On this page

Key facts

NPPES NPI Registry
Primary specialty
OptometristTaxonomy code 152W00000X
License
ODP100186 Issued in ID
Legal business name
DALLAS STEVENS OD PA
Practice address
8359 W Emerald St
Boise, ID 83704-8304
Phone
(209) 376-2062
NPI assigned
Feb 20, 2018
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Feb 20, 2018

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

Authorized official

Name
Dallas Stevens, OD PA
Title
Optometrist/ Owner
Phone
(208) 376-2062

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
OptometristGroup: 193400000X SINGLE SPECIALTY GROUP 152W00000X ODP100186 ID Primary

Addresses

Primary practice location

8359 W Emerald St
Boise, ID 83704-8304

Mailing address

8359 W Emerald St
Boise, ID 83704-8304
Phone (209) 376-2062

National Provider Directory

National Provider Directory

Practitioners & affiliated clinicians

Practitioners 2

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

NPI Registry JSON

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

{
    "created_epoch": "1519084800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1519084800000",
    "number": "1477053007",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "8359 W EMERALD ST",
            "city": "BOISE",
            "state": "ID",
            "postal_code": "837048304",
            "telephone_number": "209-376-2062"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "8359 W EMERALD ST",
            "city": "BOISE",
            "state": "ID",
            "postal_code": "837048304",
            "telephone_number": "209-376-2062"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "DALLAS STEVENS OD PA",
        "organizational_subpart": "NO",
        "enumeration_date": "2018-02-20",
        "last_updated": "2018-02-20",
        "status": "A",
        "authorized_official_last_name": "STEVENS",
        "authorized_official_first_name": "DALLAS",
        "authorized_official_title_or_position": "OPTOMETRIST/ OWNER",
        "authorized_official_telephone_number": "208-376-2062",
        "authorized_official_credential": "OD PA"
    },
    "taxonomies": [
        {
            "code": "152W00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Optometrist",
            "state": "ID",
            "license": "ODP100186",
            "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 Feb 20, 2018; 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.