NPIMap

Organization Active NPI

Eye Pros Treasure Valley

  • Optometrist
  • Meridian, ID
National Provider Identifier
1083370340
Registry record updated Feb 14, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
OptometristTaxonomy code 152W00000X
Legal business name
EYE PROS TREASURE VALLEY
Practice address
6252 N. Linder Rd.
#150
Meridian, ID 83646
Phone
(208) 297-7019
NPI assigned
Nov 11, 2021
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Feb 14, 2023

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Lavar Kofoed, ODNPI 1023231420
Title
Owner
Phone
(208) 954-9106

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
OptometristGroup: 193400000X SINGLE SPECIALTY GROUP 152W00000X Primary

Addresses

Primary practice location

6252 N. Linder Rd.
#150
Meridian, ID 83646

Mailing address

3485 N Cole Rd Unit 45479
Boise, ID 83711-1095
Phone (833) 776-2020

Other names 1

  • Eye Pros Doing business as

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in ID

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20230323000918 ID Part B Supplier - Clinic/Group Practice 5496129934 Receives reassigned benefits from 12 practitioners
Practice locations: Meridian, ID

National Provider Directory

National Provider Directory

Member of 1

Organizations this organization is a member of, according to the National Provider Directory.

Locations

3485 N Cole Rd
Unit 45479
Boise, ID 83711

6252 N Linder Rd
Ste 150
Meridian, ID 83646
Phone (208) 297-7019

6252 N Linder Rd
#250
Meridian, ID 83646

Practitioners & affiliated clinicians

Practitioners 12

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1636588800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1676332800000",
    "number": "1083370340",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3485 N COLE RD UNIT 45479",
            "city": "BOISE",
            "state": "ID",
            "postal_code": "837111095",
            "telephone_number": "833-776-2020"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "6252 N. LINDER RD.",
            "address_2": "#150",
            "city": "MERIDIAN",
            "state": "ID",
            "postal_code": "83646",
            "telephone_number": "208-297-7019"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "EYE PROS TREASURE VALLEY",
        "organizational_subpart": "NO",
        "enumeration_date": "2021-11-11",
        "last_updated": "2023-02-14",
        "certification_date": "2023-02-09",
        "status": "A",
        "authorized_official_last_name": "KOFOED",
        "authorized_official_first_name": "LAVAR",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "208-954-9106",
        "authorized_official_credential": "OD"
    },
    "taxonomies": [
        {
            "code": "152W00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Optometrist",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Eye Pros",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "Eye Pros",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Meridian, ID

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 14, 2023; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.