Tiller, Daniel L

Tiller, Daniel L is an individual health care provider with primary practice located at 901 12Th Ave S , Nampa ID 83651-4658. He recently has only one registered license in Eye and Vision Services Providers / Optometrist, which is considered as his primary health care specialty. Tiller, Daniel L can be contacted via phone (208) 466-9251.

Contact Information

Primary practice address
901 12Th Ave S Nampa ID 83651-4658
Fax: (208) 463-1714
Website:

Health care specialties

SpecialtyCodeLicense #State
Eye and Vision Services Providers / Optometrist 152W00000X ODP-696 Idaho

Profile Details

NPI number 1154314268
LBN Legal business name Tiller, Daniel L
Credentials Doctor of Optometry (OD)
Entity Individual
Sole proprietor 1 No
Enumeration date Aug 24th, 2005
Last updated Mar 10th, 2010 - about 15 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 1154314268 NPPES
Idaho Other V5475 BLUE CROSS OF ID
Idaho Other 000010015295 BLUE CROSS OF ID
Idaho MEDICAID 807007400 BLUE CROSS OF ID

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