Active NPI
Scott Lee Lillemo
- Optician
- Hayden, ID
National Provider Identifier
1316169543
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Optician
- Practice address
- 8827 N Government Way
Hayden, ID 83835-8231 - Phone
- (208) 762-3455
- NPI assigned
- May 3, 2007
- Sex
- Male
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Optician | 156FX1800X | Primary |
Addresses
Primary practice location
8827 N Government Way
Hayden, ID 83835-8231
Mailing address
8827 N Government Way
Hayden, ID 83835-8231
Phone (208) 762-3455
Other identifiers 2
| Identifier | Type | State | Issuer |
|---|---|---|---|
| V7778 | Other | ID | BLUE CROSS OF IDAHO |
| 000010138836 | Other | ID | REGENCE BLUE SHIELD OF ID |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1178150400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1215993600000",
"number": "1316169543",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "8827 N GOVERNMENT WAY",
"city": "HAYDEN",
"state": "ID",
"postal_code": "838358231",
"telephone_number": "208-762-3455"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "8827 N GOVERNMENT WAY",
"city": "HAYDEN",
"state": "ID",
"postal_code": "838358231",
"telephone_number": "208-762-3455"
}
],
"practiceLocations": [],
"basic": {
"last_name": "LILLEMO",
"first_name": "SCOTT",
"middle_name": "LEE",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2007-05-03",
"last_updated": "2008-07-14",
"status": "A"
},
"taxonomies": [
{
"code": "156FX1800X",
"taxonomy_group": "",
"desc": "Technician/Technologist, Optician",
"state": null,
"license": null,
"primary": true
}
],
"identifiers": [
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "BLUE CROSS OF IDAHO",
"identifier": "V7778",
"state": "ID"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "REGENCE BLUE SHIELD OF ID",
"identifier": "000010138836",
"state": "ID"
}
],
"endpoints": [],
"other_names": []
}Other providers in Hayden, ID
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 14, 2008; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.