Provider Demographics
NPI:1316038409
Name:PRICE, NATHAN CURRAN (OD)
Entity type:Individual
Prefix:DR
First Name:NATHAN
Middle Name:CURRAN
Last Name:PRICE
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 1:855 W 6TH S
Mailing Address - Street 2:
Mailing Address - City:MOUNTAIN HOME
Mailing Address - State:ID
Mailing Address - Zip Code:83647-3335
Mailing Address - Country:US
Mailing Address - Phone:208-587-2020
Mailing Address - Fax:208-587-3349
Practice Address - Street 1:855 W 6TH S
Practice Address - Street 2:
Practice Address - City:MOUNTAIN HOME
Practice Address - State:ID
Practice Address - Zip Code:83647-3335
Practice Address - Country:US
Practice Address - Phone:208-587-2020
Practice Address - Fax:208-587-3349
Is Sole Proprietor?:No
Enumeration Date:2006-09-27
Last Update Date:2012-05-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IDODP-966152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
ID804094500Medicaid
IDU63673Medicare UPIN
ID804094500Medicaid