Idaho Vision Development Center PLLC

Primary specialty

Vision Therapy OptometristTaxonomy code 152WV0400X

Legal business name

IDAHO VISION DEVELOPMENT CENTER PLLC

Practice address

1536 Midway Dr
Ammon, ID 83406-6912

Phone

(208) 227-8822

Fax

(208) 227-8966

NPI assigned

Jul 6, 2019

Organization subpart

No

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

Authorized official

Name

Daniel Nielson, ODNPI 1518497908

Title

Optometrist

Phone

(208) 227-8822

Specialties & licenses 1

Addresses

Locations

Practitioners 1

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

• Daniel Glenn Nielson, OD

  • Optometrist
  • Ammon, ID
  • NPI 1518497908

  Vision Therapy

  NPD (past) Authorized official

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

{
    "created_epoch": "1562371200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1562371200000",
    "number": "1952963399",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1536 MIDWAY DR",
            "city": "AMMON",
            "state": "ID",
            "postal_code": "834066912",
            "telephone_number": "208-227-8822",
            "fax_number": "208-227-8966"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1536 MIDWAY DR",
            "city": "AMMON",
            "state": "ID",
            "postal_code": "834066912",
            "telephone_number": "208-227-8822",
            "fax_number": "208-227-8966"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "IDAHO VISION DEVELOPMENT CENTER PLLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2019-07-06",
        "last_updated": "2019-07-06",
        "status": "A",
        "authorized_official_last_name": "NIELSON",
        "authorized_official_first_name": "DANIEL",
        "authorized_official_title_or_position": "OPTOMETRIST",
        "authorized_official_telephone_number": "208-227-8822",
        "authorized_official_credential": "OD"
    },
    "taxonomies": [
        {
            "code": "152WV0400X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Optometrist, Vision Therapy",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• Vision Therapy Optometrist in Ammon, ID
• Providers in Ammon, ID by specialty
• Vision Therapy Optometrist in Idaho

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 6, 2019; 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.