Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 152W00000X | Optometrist | ODP-1022 | ID |
N | 152WC0802X | Optomitrist - Corneal and Contact Lenses | ODP-1022 | ID |
N | 152WP0200X | Pediatric Optomitrist | ODP-1022 | ID |
N | 152WS0006X | Sports Vision | ODP-1022 | ID |
N | 152WX0102X | Occupational Vision | ODP-1022 | ID |
NPI | 1144263963 |
---|---|
Provider Name | Dr. Todd A. Stebel |
First Address | Boise, ID 83713 |
Second Address | Boise, ID 83713 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 13/06/2006 |
Last Update Date | 18/02/2008 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
000010137319 | REGENCE BLUE SHIELD OF ID (01) | ID |
1902007263 | GROUP NPI (01) | ID |
298349 | ALTIUS (01) | ID |
40858 | DAVIS VISION PIN (01) | ID |
8N117 | BLUE CROSS OF IDAHO GROUP (01) | ID |
U80629 | (02) | ID |
V5061 | BLUECROSS OF IDAHO (01) | ID |
V7323 | BLUE CROSS OF IDAHO (01) | ID |