Provider Demographics
NPI:1710088331
Name:FREDERICK G. DOWNARD, O.D., P.A.
Entity Type:Organization
Organization Name:FREDERICK G. DOWNARD, O.D., P.A.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER / PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:FREDERICK
Authorized Official - Middle Name:GEORGE
Authorized Official - Last Name:DOWANRD
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:208-522-6933
Mailing Address - Street 1:1990 SABIN DR
Mailing Address - Street 2:
Mailing Address - City:AMMON
Mailing Address - State:ID
Mailing Address - Zip Code:83406
Mailing Address - Country:US
Mailing Address - Phone:208-522-6933
Mailing Address - Fax:
Practice Address - Street 1:1990 SABIN DR
Practice Address - Street 2:
Practice Address - City:AMMON
Practice Address - State:ID
Practice Address - Zip Code:83406
Practice Address - Country:US
Practice Address - Phone:208-522-6933
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-26
Last Update Date:2010-08-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ID000354660152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
ID=========OtherFED TAX ID # OF COMPANY
ID=========OtherFED TAX ID # OF COMPANY