| Diamond Peak Idaho | |
|
1450 N 2nd E, Rexburg, ID 83440-5131 | |
| (208) 497-6406 | |
| (208) 359-3007 |
| Full Name | Diamond Peak Idaho |
|---|---|
| Type | Facility |
| Speciality | Optometrist |
| Location | 1450 N 2nd E, Rexburg, Idaho |
| Accepts Medicare Assignments | Medicare enrolled and accepts medicare insurance. Providers at this facility may prescribe medicare part D drugs. |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1588039127 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 152W00000X | Optometrist | ODP-959 (Idaho) | Primary |
| Provider Name | Wade Roger Demordaunt |
|---|---|
| Provider Type | Practitioner - Optometry |
| Provider Identifiers | NPI Number: 1275591711 PECOS PAC ID: 2860622875 Enrollment ID: I20160216000142 |
| Mailing Address | Practice Location Address |
|---|---|
| Diamond Peak Idaho Po Box 158, Rexburg, ID 83440-0158 Ph: (208) 497-6406 | Diamond Peak Idaho 1450 N 2nd E, Rexburg, ID 83440-5131 Ph: (208) 497-6406 |
Dr. Kreed Bowman, O.D. Optometrist Medicare: Accepting Medicare Assignments Practice Location: 76 Professional Plz, Rexburg, ID 83440 Phone: 208-356-4585 Fax: 208-356-4587 | |
Dr. Bryce Byram Thueson, O.D. Optometrist Medicare: Accepting Medicare Assignments Practice Location: 76 Professional Plz, Rexburg, ID 83440 Phone: 208-356-4585 Fax: 208-356-4587 | |
Dallas Stevens, Optometrist Medicare: Accepting Medicare Assignments Practice Location: 1232 Pleasantview, Rexburg, ID 83440 Phone: 208-709-7314 | |
Canyon View Eyecare Pllc Optometrist Medicare: Medicare Enrolled Practice Location: 74 E 1st S, Rexburg, ID 83440 Phone: 208-356-6911 | |
Dr. Nathan Cody Mortensen, OD Optometrist Medicare: Accepting Medicare Assignments Practice Location: 49 E 1st S, Rexburg, ID 83440 Phone: 208-356-4444 | |
Dr. Douglass Eugene Hanson, OPTOMETRIST Optometrist Medicare: Medicare Enrolled Practice Location: 24 E Main St, Rexburg, ID 83440 Phone: 208-356-0881 Fax: 208-359-9680 | |
Dr. Dallin Heiner, O.D. Optometrist Medicare: May Accept Medicare Assignments Practice Location: 244 E Main St, Rexburg, ID 83440 Phone: 208-359-1880 Fax: 208-359-2025 |