Eye Clinic of Sandpoint PA

Primary specialty

Eyewear SupplierTaxonomy code 332H00000X

Legal business name

EYE CLINIC OF SANDPOINT PA

Practice address

307 S 1St Ave
Sandpoint, ID 83864-1201

Phone

(208) 263-8501

NPI assigned

Mar 8, 2007

Last updated

Feb 15, 2018By the provider in NPPES

Organization subpart

No

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

Authorized official

Name

Dr. Jason M Petersen, DONPI 1407235948

Title

Physician-Owner

Phone

(208) 263-8501

Specialties & licenses 1

Addresses

Other identifiers 1

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

Tax ID family

Eye Clinic of Sandpoint2 organizations share this tax ID, including this one

Other organizations with this tax ID 1

Organizations that report the same tax identification number in the National Provider Directory.

• Eye Clinic of Sandpoint PA

  • Ophthalmology Physician
  • Sandpoint, ID
  • NPI 1215945431
  NPD tax ID

Practitioners 6

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

• Jason Petersen, O.D.

  • Optometrist
  • Sandpoint, ID
  • NPI 1407235948
  NPD Authorized official
• Charles C George, MD

  • Ophthalmology Physician
  • Sandpoint, ID
  • NPI 1194733410
  NPD (past)
• Brayden Petersen, OD

  • Optometrist
  • Sandpoint, ID
  • NPI 1932767753
  NPD (past)
• Bruce David Bellin, M.D.

  • Ophthalmology Physician
  • Omak, WA
  • NPI 1497853162
  NPD (past)
• Robert Leonard Mulvihill, MD

  • Psychiatry Physician
  • Spokane, WA
  • NPI 1003927252
  NPD (past)
• Ronald H Ullman, MD

  • Ophthalmology Physician
  • Wenatchee, WA
  • NPI 1922016203
  NPD (past)

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

{
    "created_epoch": "1173312000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1518652800000",
    "number": "1104957612",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "307 S 1ST AVE",
            "city": "SANDPOINT",
            "state": "ID",
            "postal_code": "838641201",
            "telephone_number": "208-263-8501"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "307 S 1ST AVE",
            "city": "SANDPOINT",
            "state": "ID",
            "postal_code": "838641201",
            "telephone_number": "208-263-8501"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "EYE CLINIC OF SANDPOINT PA",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-03-08",
        "last_updated": "2018-02-15",
        "status": "A",
        "authorized_official_last_name": "PETERSEN",
        "authorized_official_first_name": "JASON",
        "authorized_official_middle_name": "M",
        "authorized_official_title_or_position": "PHYSICIAN-OWNER",
        "authorized_official_telephone_number": "208-263-8501",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "DO"
    },
    "taxonomies": [
        {
            "code": "332H00000X",
            "taxonomy_group": "",
            "desc": "Eyewear Supplier",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "NORIDIAN DMERC SUPPLIER",
            "identifier": "0377150001",
            "state": "ID"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Linda Evans, LMSW
• Evebreastfeeding, PLLC
• Meredith Rae Evensen-Lynch, OTR/L
• Evergreen Idaho Healthcare Sandpoint, L.L.C. (Sandoint Assisted Living Facility)
• Eye Care for You
• Eye Clinic of Sandpoint PA
• Patricia Ann Factor, MFT
• John McLain Faggard III, M.D.
• Family Center for Occupational Therapy (All About Kids OT)
• Far North Pediatrics

• Eyewear Supplier in Sandpoint, ID
• Providers in Sandpoint, ID by specialty
• Eyewear Supplier in Idaho

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 15, 2018; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• 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.