Provider Demographics
NPI:1891798773
Name:DOWNER, LARRY V (OD)
Entity Type:Individual
Prefix:DR
First Name:LARRY
Middle Name:V
Last Name:DOWNER
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 1:1016 E LOCUST ST
Mailing Address - Street 2:
Mailing Address - City:EMMETT
Mailing Address - State:ID
Mailing Address - Zip Code:83617-2776
Mailing Address - Country:US
Mailing Address - Phone:208-365-3584
Mailing Address - Fax:208-365-2471
Practice Address - Street 1:1016 E LOCUST ST
Practice Address - Street 2:
Practice Address - City:EMMETT
Practice Address - State:ID
Practice Address - Zip Code:83617-2776
Practice Address - Country:US
Practice Address - Phone:208-365-3584
Practice Address - Fax:208-365-2471
Is Sole Proprietor?:Yes
Enumeration Date:2005-05-24
Last Update Date:2008-01-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IDODP456152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
ID000010015206OtherREGENCE BLUE SHIELD
ID34870OtherDAVIS VISION
IDV024 5OtherBLUE CROSS
IDV024 5OtherBLUE CROSS
ID34870OtherDAVIS VISION
ID0184610001Medicare NSC