NPIMap

Organization Active NPI

Vision Quest Medical Center, PA

  • Ophthalmology Physician
  • Boise, ID
National Provider Identifier
1356542542
Registry record updated Apr 6, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
Ophthalmology PhysicianTaxonomy code 207W00000X
License
O-0860 Issued in ID
Legal business name
VISION QUEST MEDICAL CENTER, PA
Practice address
5680 W Gage St
Boise, ID 83706-1326
Phone
(208) 377-3937
Fax
(208) 377-9455
NPI assigned
May 29, 2007
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Apr 6, 2023

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

Authorized official

Name
Cindy Lee Clancy
Title
Credentialing
Phone
(208) 377-3937

Specialties & licenses 3

Specialty (taxonomy)CodeLicenseStatePrimary
OptometristGroup: 193400000X MULTIPLE SINGLE SPECIALTY GROUP 152W00000X ODP-100002 ID
OptometristGroup: 193400000X MULTIPLE SINGLE SPECIALTY GROUP 152W00000X ODP-100417 ID
Ophthalmology PhysicianGroup: 193400000X MULTIPLE SINGLE SPECIALTY GROUP 207W00000X O-0860 ID Primary

Addresses

Primary practice location

5680 W Gage St
Boise, ID 83706-1326

Mailing address

5680 W Gage St
Boise, ID 83706-1326
Phone (208) 377-3937

Other practice location 1

2720 W Cherry Ln
Meridian, ID 83642-1137
Phone (208) 377-3937

Other practice location 2

350 East Ln S
Ontario, OR 97914-3058
Phone (208) 377-3937

Other practice location 3

1906 Fairview Ave
Caldwell, ID 83605-5407
Phone (208) 377-3937

Other identifiers 6

IdentifierTypeStateIssuer
000160500MedicaidID
807072200MedicaidID
807072300MedicaidID
0857720001OtherIDDMERC GROUP NO
806834700MedicaidID
001553800MedicaidID

Other names 1

  • SONNTAG EYE ASSOCIATES, PA Former legal business name

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in ID, OR2 enrollments

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
O20171220000841 ID Part B Supplier - Clinic/Group Practice 0547528598 Receives reassigned benefits from 6 practitioners
2 other NPIs on this enrollment
Practice locations: Boise, ID; Caldwell, ID; Meridian, ID
O20230811000348 OR Part B Supplier - Clinic/Group Practice 0547528598 Receives reassigned benefits from 3 practitioners
Practice locations: Ontario, OR

Other NPIs on the same Medicare enrollment 2

NPIs listed together on one Medicare enrollment, typically parts of the same organization.

National Provider Directory

National Provider Directory
Tax ID family
Sonntag Eye Associates3 organizations share this tax ID, including this one

Other organizations with this tax ID 2

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

Locations

350 East Ln S
Ontario, OR 97914
Phone (208) 322-5996

Practitioners & affiliated clinicians

Practitioners 6

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

NPI Registry JSON

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

{
    "created_epoch": "1180396800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1680739200000",
    "number": "1356542542",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "5680 W GAGE ST",
            "city": "BOISE",
            "state": "ID",
            "postal_code": "837061326",
            "telephone_number": "208-377-3937",
            "fax_number": "208-377-9455"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "5680 W GAGE ST",
            "city": "BOISE",
            "state": "ID",
            "postal_code": "837061326",
            "telephone_number": "208-377-3937",
            "fax_number": "208-377-9455"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "2720 W Cherry Ln",
            "address_purpose": "LOCATION",
            "city": "Meridian",
            "state": "ID",
            "postal_code": "836421137",
            "country_code": "US",
            "telephone_number": "208-377-3937",
            "fax_number": "208-377-9455",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "350 East Ln S",
            "address_purpose": "LOCATION",
            "city": "Ontario",
            "state": "OR",
            "postal_code": "979143058",
            "country_code": "US",
            "telephone_number": "208-377-3937",
            "fax_number": "208-377-9455",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "1906 Fairview Ave",
            "address_purpose": "LOCATION",
            "city": "Caldwell",
            "state": "ID",
            "postal_code": "836055407",
            "country_code": "US",
            "telephone_number": "208-377-3937",
            "fax_number": "208-377-9455",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "organization_name": "VISION QUEST MEDICAL CENTER, PA",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-05-29",
        "last_updated": "2023-04-06",
        "certification_date": "2023-04-06",
        "status": "A",
        "authorized_official_last_name": "CLANCY",
        "authorized_official_first_name": "CINDY",
        "authorized_official_middle_name": "LEE",
        "authorized_official_title_or_position": "CREDENTIALING",
        "authorized_official_telephone_number": "208-377-3937"
    },
    "taxonomies": [
        {
            "code": "152W00000X",
            "taxonomy_group": "193400000X MULTIPLE SINGLE SPECIALTY GROUP",
            "desc": "Optometrist",
            "state": "ID",
            "license": "ODP-100002",
            "primary": false
        },
        {
            "code": "152W00000X",
            "taxonomy_group": "193400000X MULTIPLE SINGLE SPECIALTY GROUP",
            "desc": "Optometrist",
            "state": "ID",
            "license": "ODP-100417",
            "primary": false
        },
        {
            "code": "207W00000X",
            "taxonomy_group": "193400000X MULTIPLE SINGLE SPECIALTY GROUP",
            "desc": "Ophthalmology",
            "state": "ID",
            "license": "O-0860",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "000160500",
            "state": "ID"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "807072200",
            "state": "ID"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "807072300",
            "state": "ID"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "DMERC GROUP NO",
            "identifier": "0857720001",
            "state": "ID"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "806834700",
            "state": "ID"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "001553800",
            "state": "ID"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "SONNTAG EYE ASSOCIATES, PA",
            "code": "4",
            "type": "Former Legal Business Name"
        },
        {
            "organization_name": "SONNTAG EYE ASSOCIATES, PA",
            "code": "4",
            "type": "Former Legal Business Name"
        }
    ]
}

Other providers in Boise, ID

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 6, 2023; 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.