Provider records sourced from NPPES (CMS National Plan & Provider Enumeration System). Data current as of August 10, 2026.
NPIDirectory

Landon Kelly Grange, MD

Individual provider Ophthalmology Physician · NPI 1043620255

Landon Kelly Grange, MD is an Ophthalmology in Boise, Idaho. Graduated from University of California, San Diego School of Medicine in 2014, 12 years ago. Licensed in Idaho.

Years since qualifying
12
Trained at
University of California, San Diego School of Medicine
Licensed in
ID
In the registry since
2014
What do these letters mean?
MD — Doctor of Medicine
A physician who completed allopathic medical school.

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Practice location Address checks out

5680 W Gage St
Boise, ID 83706
Phone: (208) 773-3937
Fax: (208) 377-3937
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Pin is approximate — placed at the ZIP-code centre, not the exact door.

Specialties & licences

Ophthalmology Physician (primary) Taxonomy 207W00000X · Licence M14219 (ID)

Record details

NPI number1043620255
Entity typeIndividual (Type 1)
GenderMale
Credentials MD
Sole proprietorNo
NPI enumeratedApril 28, 2014
Last updated in NPPESJuly 26, 2018

Medicare enrollment

From the CMS Doctors & Clinicians file — this clinician is enrolled in Medicare.

Medicare specialtyOPHTHALMOLOGY
Medical schoolUNIVERSITY OF CALIFORNIA, SAN DIEGO SCHOOL OF MEDICINE
Graduated 2014 (12 years in practice)
Accepts Medicare assignment Not indicated
Practice locations2 on file with Medicare

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