Organization Active NPI

Treasure Valley Eye Center P a

  • Ophthalmology Physician
  • Meridian, ID
National Provider Identifier
1336251073
Registry record updated Aug 1, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Ophthalmology PhysicianTaxonomy code 207W00000X
License
M7853 Issued in ID
Legal business name
TREASURE VALLEY EYE CENTER P A
Practice address
3045 E St Lukes St # 100
Meridian, ID 83642-3507
Phone
(208) 288-2020
Fax
(208) 288-2015
NPI assigned
Aug 31, 2006
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Aug 1, 2024

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

Authorized official

Name
Dr. Mark Robert Miller, M.D.NPI 1881629327
Title
Medical Director
Phone
(208) 706-2020

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Ophthalmology PhysicianGroup: 193400000X SINGLE SPECIALTY GROUP 207W00000X M7853 ID Primary

Addresses

Primary practice location

3045 E St Lukes St # 100
Meridian, ID 83642-3507

Mailing address

3045 E St Lukes St # 100
Meridian, ID 83642-3507
Phone (208) 288-2020

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in ID2 enrollments

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
O20070206000532 ID Part B Supplier - Clinic/Group Practice 9537161450 Receives reassigned benefits from 4 practitioners
Practice locations: Meridian, ID
O20100930058053 ID DME Supplier - Physician - General PracticeDME Supplier - Physician - OptometristDME Supplier - Optician 9537161450 Practice locations: Meridian, ID

Laboratory certificates & supplier records

Derived by NPIMap

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

SupplierSuppliesMedicare assignment
Treasure Valley Eye Center3045 E St Lukes St, Meridian, ID 83642-3507(208) 288-2020 Prosthetic Lenses: Conventional Eyeglasses|Prosthetic Lenses: Conventional Contact Lenses|Prosthetic Lenses: Prosthetics Cataract Lenses Accepts assignmentParticipating since Nov 5, 2006

National Provider Directory

National Provider Directory

Locations

3045 E St Lukes St
Ste 100
Meridian, ID 83642
Phone (208) 288-2020

Practitioners & affiliated clinicians

Practitioners 4

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.

NPI Registry JSON

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

{
    "created_epoch": "1156982400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1722470400000",
    "number": "1336251073",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3045 E ST LUKES ST # 100",
            "city": "MERIDIAN",
            "state": "ID",
            "postal_code": "836423507",
            "telephone_number": "208-288-2020",
            "fax_number": "208-288-2015"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3045 E ST LUKES ST # 100",
            "city": "MERIDIAN",
            "state": "ID",
            "postal_code": "836423507",
            "telephone_number": "208-288-2020",
            "fax_number": "208-288-2015"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "TREASURE VALLEY EYE CENTER P A",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-08-31",
        "last_updated": "2024-08-01",
        "certification_date": "2024-08-01",
        "status": "A",
        "authorized_official_last_name": "MILLER",
        "authorized_official_first_name": "MARK",
        "authorized_official_middle_name": "ROBERT",
        "authorized_official_title_or_position": "MEDICAL DIRECTOR",
        "authorized_official_telephone_number": "208-706-2020",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "M.D."
    },
    "taxonomies": [
        {
            "code": "207W00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Ophthalmology",
            "state": "ID",
            "license": "M7853",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Meridian, ID

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 1, 2024; 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.