Bonneville Vision, PLLC

Primary specialty

OptometristTaxonomy code 152W00000X

Legal business name

BONNEVILLE VISION, PLLC

Practice address

838 S Woodruff Ave
Idaho Falls, ID 83401-5296

Phone

(208) 523-3937

NPI assigned

Jul 11, 2019

Organization subpart

No

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

Authorized official

Name

Dr. Nathan Housley, ODNPI 1356903033

Title

Managing Member

Phone

(208) 523-3937

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Enrolled in ID2 enrollments

Enrollment records 2

These CMS records do not include an NPI. They are shown because their name and street address match this provider’s.

Medicare medical equipment & supply locations

Locations

Practitioners 2

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

• Nathan Housley, OD

  • Optometrist
  • Idaho Falls, ID
  • NPI 1356903033
  Medicare reassignment NPD Authorized official
• Owen M Shirts, O.D.

  • Optometrist
  • Idaho Falls, ID
  • NPI 1477612273
  NPD (past)

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

{
    "created_epoch": "1562803200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1562803200000",
    "number": "1093367971",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "838 S WOODRUFF AVE",
            "city": "IDAHO FALLS",
            "state": "ID",
            "postal_code": "834015296",
            "telephone_number": "208-523-3937"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "838 S WOODRUFF AVE",
            "city": "IDAHO FALLS",
            "state": "ID",
            "postal_code": "834015296",
            "telephone_number": "208-523-3937"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "BONNEVILLE VISION, PLLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2019-07-11",
        "last_updated": "2019-07-11",
        "status": "A",
        "authorized_official_last_name": "HOUSLEY",
        "authorized_official_first_name": "NATHAN",
        "authorized_official_title_or_position": "MANAGING MEMBER",
        "authorized_official_telephone_number": "208-523-3937",
        "authorized_official_name_prefix": "Dr.",
        "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": []
}

• Kara Dee Boll
• Nikie Greene Bone, LPC
• Bonneville County
• Bonneville School Dist #93
• Bonneville Surgery Center LLC
• Taylor Bonning, BS
• Ethan Bryan Booker, LMSW
• Julia Booker
• Brandon Derrick Borchman, PSY.D.
• Roberta J. Bostian, AGACNP

• Optometrist in Idaho Falls, ID
• Providers in Idaho Falls, ID by specialty
• Optometrist in Idaho

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 11, 2019; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.