Provider Demographics
NPI:1831182682
Name:HILBORN, DOUGLAS JAMES (OD)
Entity type:Individual
Prefix:DR
First Name:DOUGLAS
Middle Name:JAMES
Last Name:HILBORN
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 1:1880 TIFFANY DR
Mailing Address - Street 2:
Mailing Address - City:IDAHO FALLS
Mailing Address - State:ID
Mailing Address - Zip Code:83404-6129
Mailing Address - Country:US
Mailing Address - Phone:208-524-4668
Mailing Address - Fax:
Practice Address - Street 1:1991 W BROADWAY ST
Practice Address - Street 2:SUITE 2
Practice Address - City:IDAHO FALLS
Practice Address - State:ID
Practice Address - Zip Code:83402-3041
Practice Address - Country:US
Practice Address - Phone:208-529-4333
Practice Address - Fax:208-529-4366
Is Sole Proprietor?:No
Enumeration Date:2005-08-26
Last Update Date:2008-10-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IDODP-546152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
ID1505148Medicaid
ID1591573Medicare ID - Type Unspecified
ID1505148Medicaid