Gem State Family Eyecare, P.C.

Primary specialty

OptometristTaxonomy code 152W00000X

License

ODP-100213 Issued in ID

Legal business name

GEM STATE FAMILY EYECARE, P.C.

Practice address

3815 W State St
Boise, ID 83703-5221

Phone

(208) 345-6886

Fax

(208) 345-6686

NPI assigned

Dec 22, 2011

Last updated

Dec 22, 2011By 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. Jennifer Marie Holman, O.D.

Title

President

Phone

(208) 345-6886

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Enrolled in ID

Enrollment records 1

Locations

Practitioners 2

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.

• Marisa Denise Brown, ODP

  • Optometrist
  • Boise, ID
  • NPI 1992321327
  Medicare reassignment NPD
• Jennifer Marie Drean, O.D.

  • Optometrist
  • Boise, ID
  • NPI 1417262767
  Medicare reassignment NPD

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

{
    "created_epoch": "1324512000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1324512000000",
    "number": "1154690923",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3815 W STATE ST",
            "city": "BOISE",
            "state": "ID",
            "postal_code": "837035221",
            "telephone_number": "208-345-6886",
            "fax_number": "208-345-6686"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3815 W STATE ST",
            "city": "BOISE",
            "state": "ID",
            "postal_code": "837035221",
            "telephone_number": "208-345-6886",
            "fax_number": "208-345-6686"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "GEM STATE FAMILY EYECARE, P.C.",
        "organizational_subpart": "NO",
        "enumeration_date": "2011-12-22",
        "last_updated": "2011-12-22",
        "status": "A",
        "authorized_official_last_name": "HOLMAN",
        "authorized_official_first_name": "JENNIFER",
        "authorized_official_middle_name": "MARIE",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "208-345-6886",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "O.D."
    },
    "taxonomies": [
        {
            "code": "152W00000X",
            "taxonomy_group": "",
            "desc": "Optometrist",
            "state": "ID",
            "license": "ODP-100213",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Anna L Gelok, PA-C
• Christian Gelok, CNP
• Gem State Care Mobility LLC
• Gem State Counseling and Therapeutic Services
• Gem State Dermatology, PA
• Gem State Radiology LLP
• Gem State Speech Inc
• Gem State Therapy (Gem State Wellness)
• Gemba Boise LLC (Gemba Boise)
• Gemba Boise, LLC

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

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 22, 2011; 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.