Elmore County Eyecare, PA.
Organization Active NPI Optometrist · Mountain Home, ID
NPI 1003973736 · NPPES record last updated Mar 5, 2012
Key facts
- NPI
- 1003973736
- Entity type
- Organization (NPI type 2)
- Primary specialty
- Optometrist 152W00000X
- License
- ODP-995, ODP-966 (ID)
- Legal business name
- ELMORE COUNTY EYECARE, PA.
- Practice address
- 855 West 6TH South
Mountain Home, ID 83647-3335 - Phone
- (208) 587-2020
- Fax
- (208) 587-3349
- NPI assigned
- Jan 2, 2007
- Organization subpart
- No
Authorized official
- Name
- Dr. Nathan Curran Price, O.D.
- Title
- President
- Phone
- (208) 587-2020
Practitioners 3
-
Kyle J Kenison, O.D.
-
Nathan Curran Price, O.D.
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in ID
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| O20080530000542 | ID | Part B Supplier - Clinic/Group Practice | 6103996335 |
Receives reassigned benefits from 3 practitioners Practice locations: Mountain Home, ID |
National Provider Directory
Locations
855 W Airbase Rd
Mountain Home, ID 83647
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Optometrist |
152W00000X | ODP-995, ODP-966 | ID | Yes |
Addresses
Primary practice location
855 West 6TH South
Mountain Home, ID 83647-3335
Mailing address
855 W 6TH S
Mountain Home, ID 83647-3335
Phone (208) 587-2020
Other identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1568427615 | Medicaid | ID | |
| 1003973736 | Medicaid | ID | |
| 1316038409 | Medicaid | ID |
Other providers in Mountain Home, ID
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Mar 5, 2012. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.