NPIMap

Organization Active NPI

Bluebird Family Eye Care PLLC

  • Optometrist
  • Blackfoot, ID
National Provider Identifier
1629615158
Registry record updated Jan 16, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
OptometristTaxonomy code 152W00000X
Legal business name
BLUEBIRD FAMILY EYE CARE PLLC
Practice address
720 N Meridian St Ste a
Blackfoot, ID 83221-4936
Phone
(208) 785-7274
Fax
(208) 785-7274
NPI assigned
Dec 3, 2019
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jan 16, 2020

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

Authorized official

Name
Cody Jones, ODNPI 1255426912
Title
Owner
Phone
(208) 785-7274

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
OptometristGroup: 193200000X MULTI-SPECIALTY GROUP 152W00000X Primary
Vision Therapy OptometristGroup: 193200000X MULTI-SPECIALTY GROUP 152WV0400X

Addresses

Primary practice location

720 N Meridian St Ste a
Blackfoot, ID 83221-4936

Mailing address

720 N Meridian St Ste a
Blackfoot, ID 83221-4936
Phone (208) 785-7274

Other practice location 1

2540 Channing Way
Idaho Falls, ID 83404-7515
Phone (208) 529-2700

Other identifiers 1

IdentifierTypeStateIssuer
1477793222MedicaidID

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20200612000516 ID Part B Supplier - Clinic/Group Practice 2668894007 Receives reassigned benefits from 4 practitioners
Practice locations: Blackfoot, ID; Idaho Falls, ID; Pocatello, ID

National Provider Directory

National Provider Directory

Locations

720 N Meridian St
#A
Blackfoot, ID 83221
Phone (208) 785-7274

Practitioners & affiliated clinicians

Practitioners 4

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": "1575331200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1579132800000",
    "number": "1629615158",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "720 N MERIDIAN ST STE A",
            "city": "BLACKFOOT",
            "state": "ID",
            "postal_code": "832214936",
            "telephone_number": "208-785-7274"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "720 N MERIDIAN ST STE A",
            "city": "BLACKFOOT",
            "state": "ID",
            "postal_code": "832214936",
            "telephone_number": "208-785-7274",
            "fax_number": "208-785-7274"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "2540 Channing Way",
            "address_purpose": "LOCATION",
            "city": "Idaho Falls",
            "state": "ID",
            "postal_code": "834047515",
            "country_code": "US",
            "telephone_number": "208-529-2700",
            "fax_number": "208-529-0873",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "organization_name": "BLUEBIRD FAMILY EYE CARE PLLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2019-12-03",
        "last_updated": "2020-01-16",
        "certification_date": "2020-01-16",
        "status": "A",
        "authorized_official_last_name": "JONES",
        "authorized_official_first_name": "CODY",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "208-785-7274",
        "authorized_official_credential": "OD"
    },
    "taxonomies": [
        {
            "code": "152W00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Optometrist",
            "state": null,
            "license": null,
            "primary": true
        },
        {
            "code": "152WV0400X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Optometrist, Vision Therapy",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1477793222",
            "state": "ID"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Blackfoot, ID

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 16, 2020; 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.