Provider Demographics
NPI:1457716482
Name:BRYCE B. THUESON, O.D., PLLC
Entity Type:Organization
Organization Name:BRYCE B. THUESON, O.D., PLLC
Other - Org Name:TODAY'S EYE CARE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:BRYCE
Authorized Official - Middle Name:B
Authorized Official - Last Name:THUESON
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:208-356-4585
Mailing Address - Street 1:76 PROFESSIONAL PLZ
Mailing Address - Street 2:
Mailing Address - City:REXBURG
Mailing Address - State:ID
Mailing Address - Zip Code:83440-2047
Mailing Address - Country:US
Mailing Address - Phone:208-356-4585
Mailing Address - Fax:208-356-4587
Practice Address - Street 1:76 PROFESSIONAL PLZ
Practice Address - Street 2:
Practice Address - City:REXBURG
Practice Address - State:ID
Practice Address - Zip Code:83440-2047
Practice Address - Country:US
Practice Address - Phone:208-356-4585
Practice Address - Fax:208-356-4587
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-12-17
Last Update Date:2015-12-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IDODP100014152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IDU95270Medicare UPIN
IDT44304Medicare UPIN