Provider Demographics
NPI:1558629535
Name:BLIZZARD, SONYA THOMAS (MD)
Entity Type:Individual
Prefix:
First Name:SONYA
Middle Name:THOMAS
Last Name:BLIZZARD
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2600 E SELTICE WAY
Mailing Address - Street 2:STE A PMB 277
Mailing Address - City:POST FALLS
Mailing Address - State:ID
Mailing Address - Zip Code:83854
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:2175 N MAIN ST
Practice Address - Street 2:
Practice Address - City:COEUR D ALENE
Practice Address - State:ID
Practice Address - Zip Code:83814-5768
Practice Address - Country:US
Practice Address - Phone:208-664-9888
Practice Address - Fax:208-666-0816
Is Sole Proprietor?:No
Enumeration Date:2012-04-27
Last Update Date:2020-02-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDP29020207W00000X
NC2016-00555207W00000X
IDM-13914207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology