Gary R. Pabalis, O.D.

Primary specialty

OptometristTaxonomy code 152W00000X

License

ODP-100002 Issued in ID

Practice address

5680 W Gage St
Boise, ID 83706-1326

Phone

(208) 377-3937

Fax

(208) 377-9455

NPI assigned

Jun 16, 2005

Sex

Male

Sole proprietor

No

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

Specialties & licenses 3

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Enrolled

State licenses

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

{
    "created_epoch": "1118880000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1683504000000",
    "number": "1396740262",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "11972 W GAMEKEEPER DR",
            "city": "KUNA",
            "state": "ID",
            "postal_code": "836342802",
            "telephone_number": "208-562-6285",
            "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"
        }
    ],
    "basic": {
        "last_name": "PABALIS",
        "first_name": "GARY",
        "middle_name": "R.",
        "name_prefix": "Dr.",
        "credential": "O.D.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2005-06-16",
        "last_updated": "2023-05-08",
        "certification_date": "2023-05-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "152W00000X",
            "taxonomy_group": "",
            "desc": "Optometrist",
            "state": "ID",
            "license": "ODP-100002",
            "primary": true
        },
        {
            "code": "152W00000X",
            "taxonomy_group": "",
            "desc": "Optometrist",
            "state": "AZ",
            "license": "295",
            "primary": false
        },
        {
            "code": "152W00000X",
            "taxonomy_group": "",
            "desc": "Optometrist",
            "state": "UT",
            "license": "114212-9934",
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "806834700",
            "state": "ID"
        }
    ],
    "endpoints": [],
    "other_names": []
}

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• 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 May 8, 2023; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.