NPIMap

Organization Active NPI

Idaho Eye Pros Idaho Falls LLC

Doing business as Eye Pros

  • Optometrist
  • Idaho Falls, ID
National Provider Identifier
1528494465
Registry record updated Mar 26, 2021
On this page

Key facts

NPPES NPI Registry
Primary specialty
OptometristTaxonomy code 152W00000X
Legal business name
IDAHO EYE PROS IDAHO FALLS LLC
Doing business as
Eye Pros
Idaho Eye Pros
Practice address
2990 S 25TH E
Idaho Falls, ID 83404-6515
Phone
(208) 535-2604
Fax
(208) 522-0861
NPI assigned
Sep 24, 2013
Last updated
Mar 26, 2021By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Mar 26, 2021

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

Authorized official

Name
Laurel George
Title
Account Manager
Phone
(208) 954-9106

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Optometrist 152W00000X Primary

Addresses

Primary practice location

2990 S 25TH E
Idaho Falls, ID 83404-6515

Mailing address

3485 N Cole Rd Unit 45479
Boise, ID 83711-1095
Phone (208) 297-7019

Other identifiers 1

IdentifierTypeStateIssuer
20006642OtherIDPTAN

Other names 2

  • Eye Pros Doing business as
  • Idaho Eye Pros Doing business as

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in ID

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20150418000011 ID Part B Supplier - Clinic/Group Practice 6507184744 Receives reassigned benefits from 7 practitioners
Practice locations: Idaho Falls, ID

National Provider Directory

National Provider Directory

Member of 1

Organizations this organization is a member of, according to the National Provider Directory.

Locations

3485 N Cole Rd
Unit 45479
Boise, ID 83711

Practitioners & affiliated clinicians

Practitioners 7

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": "1379980800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1616716800000",
    "number": "1528494465",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3485 N COLE RD UNIT 45479",
            "city": "BOISE",
            "state": "ID",
            "postal_code": "837111095",
            "telephone_number": "208-297-7019",
            "fax_number": "208-297-7518"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2990 S 25TH E",
            "city": "IDAHO FALLS",
            "state": "ID",
            "postal_code": "834046515",
            "telephone_number": "208-535-2604",
            "fax_number": "208-522-0861"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "IDAHO EYE PROS IDAHO FALLS LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2013-09-24",
        "last_updated": "2021-03-26",
        "certification_date": "2021-03-26",
        "status": "A",
        "authorized_official_last_name": "GEORGE",
        "authorized_official_first_name": "LAUREL",
        "authorized_official_title_or_position": "ACCOUNT MANAGER",
        "authorized_official_telephone_number": "208-954-9106"
    },
    "taxonomies": [
        {
            "code": "152W00000X",
            "taxonomy_group": "",
            "desc": "Optometrist",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "PTAN",
            "identifier": "20006642",
            "state": "ID"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Eye Pros",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "Idaho Eye Pros",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "Idaho Eye Pros",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Idaho Falls, ID

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 26, 2021; 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.