Provider Demographics
NPI:1225294333
Name:TODD F BIRCH.O.D.
Entity Type:Organization
Organization Name:TODD F BIRCH.O.D.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:TODD
Authorized Official - Middle Name:F
Authorized Official - Last Name:BIRCH
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:208-522-5594
Mailing Address - Street 1:45 W 1ST N
Mailing Address - Street 2:
Mailing Address - City:SAINT ANTHONY
Mailing Address - State:ID
Mailing Address - Zip Code:83445-1401
Mailing Address - Country:US
Mailing Address - Phone:208-624-3231
Mailing Address - Fax:
Practice Address - Street 1:45 W 1ST N
Practice Address - Street 2:
Practice Address - City:SAINT ANTHONY
Practice Address - State:ID
Practice Address - Zip Code:83445-1401
Practice Address - Country:US
Practice Address - Phone:208-624-3231
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-07-29
Last Update Date:2008-07-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
ID1373634Medicare PIN