Provider Demographics
NPI:1134151293
Name:EVANS, DANIEL NILE (OD)
Entity type:Individual
Prefix:DR
First Name:DANIEL
Middle Name:NILE
Last Name:EVANS
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 1:2823 N WHITWORTH RD
Mailing Address - Street 2:
Mailing Address - City:INKOM
Mailing Address - State:ID
Mailing Address - Zip Code:83245-1741
Mailing Address - Country:US
Mailing Address - Phone:208-775-4439
Mailing Address - Fax:
Practice Address - Street 1:2120 THAIN GRADE
Practice Address - Street 2:
Practice Address - City:LEWISTON
Practice Address - State:ID
Practice Address - Zip Code:83501-4105
Practice Address - Country:US
Practice Address - Phone:208-746-1050
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-07-07
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IDODP-100110152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist