Provider Demographics
NPI:1881792695
Name:NIELD, CHRISTOPHER ANDREW (OD)
Entity type:Individual
Prefix:
First Name:CHRISTOPHER
Middle Name:ANDREW
Last Name:NIELD
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 1:1141 PACKER DR
Mailing Address - Street 2:
Mailing Address - City:BLACKFOOT
Mailing Address - State:ID
Mailing Address - Zip Code:83221-3657
Mailing Address - Country:US
Mailing Address - Phone:208-238-5455
Mailing Address - Fax:208-238-5481
Practice Address - Street 1:MISSION RD
Practice Address - Street 2:
Practice Address - City:FORT HALL
Practice Address - State:ID
Practice Address - Zip Code:83203-0717
Practice Address - Country:US
Practice Address - Phone:208-238-5441
Practice Address - Fax:208-238-5481
Is Sole Proprietor?:No
Enumeration Date:2006-09-20
Last Update Date:2007-07-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IDODP-1019152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
ID003398900Medicaid
IDU97582Medicare UPIN