NPIMap

Organization Active NPI

Total Vision PA

  • Corneal and Contact Management Optometrist
  • Caldwell, ID
National Provider Identifier
1447328463
Registry record updated Jun 28, 2010
On this page

Key facts

NPPES NPI Registry
Primary specialty
Corneal and Contact Management OptometristTaxonomy code 152WC0802X
License
ODP-579 Issued in ID
Legal business name
TOTAL VISION PA
Practice address
1702 S Kimball Ave
Caldwell, ID 83605-4826
Phone
(208) 459-2641
Fax
(208) 459-2895
NPI assigned
Nov 30, 2006
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jun 28, 2010

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

Authorized official

Name
Ms. Sheree C Shannon
Title
Administrative Assistant
Phone
(208) 459-2641

Specialties & licenses 9

Specialty (taxonomy)CodeLicenseStatePrimary
OptometristGroup: 193200000X MULTI-SPECIALTY GROUP 152W00000X ODP-579 ID
OptometristGroup: 193200000X MULTI-SPECIALTY GROUP 152W00000X ODP100163 ID
Corneal and Contact Management OptometristGroup: 193200000X MULTI-SPECIALTY GROUP 152WC0802X ODP-579 ID Primary
Corneal and Contact Management OptometristGroup: 193200000X MULTI-SPECIALTY GROUP 152WC0802X ODP100163 ID
Low Vision Rehabilitation OptometristGroup: 193200000X MULTI-SPECIALTY GROUP 152WL0500X ODP100163 ID
Pediatric OptometristGroup: 193200000X MULTI-SPECIALTY GROUP 152WP0200X ODP-579 ID
Pediatric OptometristGroup: 193200000X MULTI-SPECIALTY GROUP 152WP0200X ODP100163 ID
Sports Vision OptometristGroup: 193200000X MULTI-SPECIALTY GROUP 152WS0006X ODP100163 ID
Occupational Vision OptometristGroup: 193200000X MULTI-SPECIALTY GROUP 152WX0102X ODP100163 ID

Addresses

Primary practice location

1702 S Kimball Ave
Caldwell, ID 83605-4826

Mailing address

1702 S Kimball Ave
Caldwell, ID 83605-4826
Phone (208) 459-2641

Other identifiers 2

IdentifierTypeStateIssuer
807869000MedicaidID
V9055OtherIDBLUE CROSS OF IDAHO GROUP

National Provider Directory

National Provider Directory

Locations

1702 S Kimball Ave
Caldwell, ID 83605
Phone (208) 459-2641

Practitioners & affiliated clinicians

Practitioners 8

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": "1164844800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1277683200000",
    "number": "1447328463",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1702 S KIMBALL AVE",
            "city": "CALDWELL",
            "state": "ID",
            "postal_code": "836054826",
            "telephone_number": "208-459-2641",
            "fax_number": "208-459-2895"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1702 S KIMBALL AVE",
            "city": "CALDWELL",
            "state": "ID",
            "postal_code": "836054826",
            "telephone_number": "208-459-2641",
            "fax_number": "208-459-2895"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "TOTAL VISION PA",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-11-30",
        "last_updated": "2010-06-28",
        "status": "A",
        "authorized_official_last_name": "SHANNON",
        "authorized_official_first_name": "SHEREE",
        "authorized_official_middle_name": "C",
        "authorized_official_title_or_position": "ADMINISTRATIVE ASSISTANT",
        "authorized_official_telephone_number": "208-459-2641",
        "authorized_official_name_prefix": "Ms."
    },
    "taxonomies": [
        {
            "code": "152W00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Optometrist",
            "state": "ID",
            "license": "ODP-579",
            "primary": false
        },
        {
            "code": "152W00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Optometrist",
            "state": "ID",
            "license": "ODP100163",
            "primary": false
        },
        {
            "code": "152WC0802X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Optometrist, Corneal and Contact Management",
            "state": "ID",
            "license": "ODP-579",
            "primary": true
        },
        {
            "code": "152WC0802X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Optometrist, Corneal and Contact Management",
            "state": "ID",
            "license": "ODP100163",
            "primary": false
        },
        {
            "code": "152WL0500X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Optometrist, Low Vision Rehabilitation",
            "state": "ID",
            "license": "ODP100163",
            "primary": false
        },
        {
            "code": "152WP0200X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Optometrist, Pediatrics",
            "state": "ID",
            "license": "ODP-579",
            "primary": false
        },
        {
            "code": "152WP0200X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Optometrist, Pediatrics",
            "state": "ID",
            "license": "ODP100163",
            "primary": false
        },
        {
            "code": "152WS0006X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Optometrist, Sports Vision",
            "state": "ID",
            "license": "ODP100163",
            "primary": false
        },
        {
            "code": "152WX0102X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Optometrist, Occupational Vision",
            "state": "ID",
            "license": "ODP100163",
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "807869000",
            "state": "ID"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BLUE CROSS OF IDAHO GROUP",
            "identifier": "V9055",
            "state": "ID"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Caldwell, ID

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 28, 2010; 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.