Provider Demographics
NPI:1285624601
Name:CALDERWOOD, JOHN L (OD)
Entity type:Individual
Prefix:DR
First Name:JOHN
Middle Name:L
Last Name:CALDERWOOD
Suffix:
Gender:M
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1814 LINCOLN WAY
Mailing Address - Street 2:
Mailing Address - City:COEUR D ALENE
Mailing Address - State:ID
Mailing Address - Zip Code:83814-2540
Mailing Address - Country:US
Mailing Address - Phone:208-667-2531
Mailing Address - Fax:208-667-7730
Practice Address - Street 1:1814 LINCOLN WAY
Practice Address - Street 2:
Practice Address - City:COEUR D ALENE
Practice Address - State:ID
Practice Address - Zip Code:83814-2540
Practice Address - Country:US
Practice Address - Phone:208-667-2531
Practice Address - Fax:208-667-7730
Is Sole Proprietor?:Yes
Enumeration Date:2005-10-26
Last Update Date:2023-08-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAOD00003976152W00000X
IDODP100067152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
ID807139301Medicaid
ID000010149991OtherREGENCE BLUE SHIELD OF IDAHO
WA2031565Medicaid
WA2031573Medicaid
IDV9030OtherBLUE CROSS OF IDAHO
ID000010149990OtherREGENCE BLUE SHIELD OF IDAHO
ID000010171389OtherREGENCE BLUE SHIELD OF IDAHO
WA196382OtherLABOR & INDUSTRIES
WA8905514OtherCRIME VICTIMS
ID807139300Medicaid
WAOMXPR0072446OtherMOLINA HEALTHCARE
WA8905514OtherCRIME VICTIMS
ID807139301Medicaid
V05106Medicare UPIN
WA2031573Medicaid