Provider Demographics
NPI:1740231737
Name:DAYTON, DREW C (OD)
Entity Type:Individual
Prefix:DR
First Name:DREW
Middle Name:C
Last Name:DAYTON
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 1:2100 PROVIDENCE WAY
Mailing Address - Street 2:
Mailing Address - City:IDAHO FALLS
Mailing Address - State:ID
Mailing Address - Zip Code:83404-4951
Mailing Address - Country:US
Mailing Address - Phone:208-529-6600
Mailing Address - Fax:208-529-6602
Practice Address - Street 1:2100 PROVIDENCE WAY
Practice Address - Street 2:
Practice Address - City:IDAHO FALLS
Practice Address - State:ID
Practice Address - Zip Code:83404-4951
Practice Address - Country:US
Practice Address - Phone:208-529-6600
Practice Address - Fax:208-529-6602
Is Sole Proprietor?:Yes
Enumeration Date:2006-05-13
Last Update Date:2022-08-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IDODP-823152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
ID000308500Medicaid
IDU09949Medicare UPIN