Provider Demographics
NPI:1952477242
Name:BIRCH, TODD F (OD)
Entity Type:Individual
Prefix:DR
First Name:TODD
Middle Name:F
Last Name:BIRCH
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 1:3351 MERLIN DR
Mailing Address - Street 2:
Mailing Address - City:IDAHO FALLS
Mailing Address - State:ID
Mailing Address - Zip Code:83404-7405
Mailing Address - Country:US
Mailing Address - Phone:208-522-5594
Mailing Address - Fax:208-552-2240
Practice Address - Street 1:3351 MERLIN DR
Practice Address - Street 2:
Practice Address - City:IDAHO FALLS
Practice Address - State:ID
Practice Address - Zip Code:83404-7405
Practice Address - Country:US
Practice Address - Phone:208-522-5594
Practice Address - Fax:208-552-2240
Is Sole Proprietor?:No
Enumeration Date:2006-11-28
Last Update Date:2011-10-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IDODP-841152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
ID002739800Medicaid
0876050002Medicare NSC
ID1373634Medicare PIN
IDU25026Medicare UPIN
ID1373636Medicare PIN