Teton Retinal Institute PA

Primary specialty

Ophthalmology PhysicianTaxonomy code 207W00000X

License

M6263 Issued in ID

Legal business name

TETON RETINAL INSTITUTE PA

Practice address

3544 E 17TH St
Ste 105
Ammon, ID 83406-6911

Phone

(208) 535-4900

Fax

(208) 535-4906

NPI assigned

Mar 20, 2007

Last updated

Nov 18, 2015By 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. Darryl G Moffett Jr., MDNPI 1003858465

Title

President

Phone

(208) 535-4900

Specialties & licenses 1

Addresses

Other identifiers 1

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.

• Darryl G Moffett Jr., M.D.

  • Ophthalmology Physician
  • Ammon, ID
  • NPI 1003858465
  Medicare reassignment NPD Authorized official
• Scott C Simpson, M.D.

  • Ophthalmology Physician
  • Meridian, ID
  • NPI 1083656334

  Single Specialty

  NPD (past)

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

{
    "created_epoch": "1174348800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1447804800000",
    "number": "1437274057",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3544 E 17TH ST",
            "address_2": "STE 105",
            "city": "AMMON",
            "state": "ID",
            "postal_code": "834066911",
            "telephone_number": "208-535-4900",
            "fax_number": "208-535-4906"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3544 E 17TH ST",
            "address_2": "STE 105",
            "city": "AMMON",
            "state": "ID",
            "postal_code": "834066911",
            "telephone_number": "208-535-4900",
            "fax_number": "208-535-4906"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "TETON RETINAL INSTITUTE PA",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-03-20",
        "last_updated": "2015-11-18",
        "status": "A",
        "authorized_official_last_name": "MOFFETT",
        "authorized_official_first_name": "DARRYL",
        "authorized_official_middle_name": "G",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "208-535-4900",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_name_suffix": "Jr.",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "207W00000X",
            "taxonomy_group": "",
            "desc": "Ophthalmology",
            "state": "ID",
            "license": "M6263",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BLUE CROSS GROUP",
            "identifier": "8G320",
            "state": "ID"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Sunrise Smiles
• Ethan Aldon Tall, PT, DPT
• Aaron Taylor, OD
• Mark S Taylor, PT
• Teton Pharmacy in Ammon
• The American Health Corporation
• The Chidlren's Center
• The Children's Center
• The Children's Center
• The Children's Center

• Ophthalmology Physician in Ammon, ID
• Providers in Ammon, ID by specialty
• Ophthalmology Physician in Idaho

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 18, 2015; 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.