Provider Demographics
NPI:1962441303
Name:BOESPFLUG, DANIEL RICHARD (OD)
Entity Type:Individual
Prefix:DR
First Name:DANIEL
Middle Name:RICHARD
Last Name:BOESPFLUG
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 1:3293 N MILWAUKEE ST
Mailing Address - Street 2:
Mailing Address - City:BOISE
Mailing Address - State:ID
Mailing Address - Zip Code:83704-4446
Mailing Address - Country:US
Mailing Address - Phone:208-322-2020
Mailing Address - Fax:208-322-1192
Practice Address - Street 1:3293 N MILWAUKEE ST
Practice Address - Street 2:
Practice Address - City:BOISE
Practice Address - State:ID
Practice Address - Zip Code:83704-4446
Practice Address - Country:US
Practice Address - Phone:208-322-2020
Practice Address - Fax:208-322-1192
Is Sole Proprietor?:No
Enumeration Date:2006-06-04
Last Update Date:2010-06-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ID0-683152W00000X, 152WC0802X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
No152WC0802XEye and Vision Services ProvidersOptometristCorneal and Contact Management
Provider Identifiers
StateIdentifier IDID TypeIssuer
ID2728000Medicaid
ID0198230001OtherCIGNA SUPPLIER
IDV6838OtherBLUE CROSS
ID000010015186OtherBLUE SHIELD
ID0198230001OtherCIGNA SUPPLIER