Alameda Vision Inc.
Organization Active NPI Optometrist · Pocatello, ID
NPI 1114901535 · NPPES record last updated Aug 29, 2011
Key facts
- NPI
- 1114901535
- Entity type
- Organization (NPI type 2)
- Primary specialty
- Optometrist 152W00000X
- Legal business name
- ALAMEDA VISION INC.
- Practice address
- 1155 Pocatello Creek Rd
Pocatello, ID 83201-2949 - Phone
- (208) 233-2020
- Fax
- (208) 233-2021
- NPI assigned
- Nov 30, 2005
- Organization subpart
- No
Authorized official
- Name
- Janece Fowers
- Title
- Billing Manager
- Phone
- (208) 233-2020
Practitioners 3
-
Ryan Scott Johnson, O.D.
-
Coleman Stokes Anderson, O.D.
-
Michael A Tucker, O.D.
Laboratory certificates & supplier records
CLIA laboratory certificates
| CLIA number | Laboratory | Certificate | Expires |
|---|---|---|---|
| 13D2067990 | Alameda Vision Center | Certificate of waiver | Oct 24, 2027 |
Medicare medical equipment & supply locations
| Supplier | Supplies | Medicare assignment |
|---|---|---|
| Alameda Vision Center |
Prosthetic Lenses: Conventional Eyeglasses|Prosthetic Lenses: Conventional Contact Lenses | Accepts assignment |
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled (2 enrollments) in ID
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| O20100930002164 | ID | DME Supplier - Physician - Optometrist | 6608995303 | Practice locations: Pocatello, ID |
| O20120313000639 | ID | Part B Supplier - Clinic/Group Practice | 6608995303 |
Receives reassigned benefits from 3 practitioners Practice locations: Pcocatello, ID |
National Provider Directory
Locations
1155 Pocatello Creek Rd
Ste Z
Pocatello, ID 83201
Phone (208) 233-2020
1155 Pocatello Creek Rd
#1
Pocatello, ID 83201
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Optometrist |
152W00000X | Yes |
Addresses
Primary practice location
1155 Pocatello Creek Rd
Pocatello, ID 83201-2949
Mailing address
1155 Pocatello Creek Rd
Pocatello, ID 83201-2949
Phone (208) 233-2020
Other identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| U2498 | Other | BC | |
| 82413 | Other | BS | |
| CP9184 | Other | ID | RR MEDICARE |
Other providers in Pocatello, ID
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Aug 29, 2011. 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.
- Medicare Care Compare provider data (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.