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

Primary practice address
225 W Main St Rigby ID 83442-1351
Phone: (208) 745-8773
Fax:
Website:
Map and Directions

Health care specialties

SpecialtyCodeLicense #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 14 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.

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Identifiers

StateTypeNumberIssuer
All States NPI 1851302855 NPPES
Idaho MEDICAID 002382900
Idaho Other 410015645

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