Hansen, Dwight
Hansen, Dwight is an sole proprietor health care provider with primary practice located at 225 W Main St , Rigby ID 83442-1351. He recently has 5 registered licenses in different health care specialties including Eye and Vision Services Providers / Optometrist, Eye and Vision Services Providers / Corneal and Contact Management, Eye and Vision Services Providers / Low Vision Rehabilitation, Eye and Vision Services Providers / Pediatrics, Eye and Vision Services Providers / Occupational Vision. Eye and Vision Services Providers / Optometrist is his primary health care specialty. Hansen, Dwight can be contacted via phone (208) 745-8773.Contact Information
Health care specialties
Specialty | Code | License # | State |
---|---|---|---|
Eye and Vision Services Providers / Optometrist | 152W00000X | ODP-747 | Idaho |
Eye and Vision Services Providers / Corneal and Contact Management | 152WC0802X | ODP-747 | Idaho |
Eye and Vision Services Providers / Low Vision Rehabilitation | 152WL0500X | ODP-747 | Idaho |
Eye and Vision Services Providers / Pediatrics | 152WP0200X | ODP-747 | Idaho |
Eye and Vision Services Providers / Occupational Vision | 152WX0102X | ODP-747 | Idaho |
Profile Details
NPI number | 1851302855 |
---|---|
LBN Legal business name | Hansen, Dwight |
Credentials | Doctor of Optometry (OD) |
Entity | Individual |
Sole proprietor 1 | Yes |
Enumeration date | Aug 11th, 2006 |
Last updated | Feb 10th, 2012 - about 13 years ago |
1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.
Identifiers
State | Type | Number | Issuer |
---|---|---|---|
All States | NPI | 1851302855 | NPPES |
Idaho | MEDICAID | 002382900 | |
Idaho | Other | 410015645 |
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