NPIMap

Organization Active NPI

Eagle Vision One PLLC

  • Optometrist
  • Eagle, ID
National Provider Identifier
1699845503
Registry record updated Jun 15, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
OptometristTaxonomy code 152W00000X
Legal business name
EAGLE VISION ONE PLLC
Practice address
355 S Eagle Rd
Eagle, ID 83616-5912
Phone
(208) 939-2773
Fax
(208) 939-5755
NPI assigned
Nov 8, 2006
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jun 15, 2023

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

Authorized official

Name
Aaron J. Warner, ODNPI 1750346524
Title
Owner
Phone
(208) 938-2015

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 1

Specialty (taxonomy)CodeLicenseStatePrimary
OptometristGroup: 193400000X SINGLE SPECIALTY GROUP 152W00000X Primary

Addresses

Primary practice location

355 S Eagle Rd
Eagle, ID 83616-5912

Mailing address

355 S Eagle Rd
Eagle, ID 83616-5912
Phone (208) 939-2773

Other practice location 1

4574 N Ten Mile Rd Ste 100
Meridian, ID 83646-7129
Phone (208) 938-2015

Other identifiers 4

IdentifierTypeStateIssuer
000010135320OtherIDBLUE SHIELD
V4916OtherIDBLUE CROSS
5675480001OtherIDMEDICARE DMERC
806190300MedicaidID

Other names 1

  • Vision One Eagle Doing business as

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20040520000894 ID Part B Supplier - Clinic/Group Practice 8921099730 Receives reassigned benefits from 11 practitioners
Practice locations: Eagle, ID; Meridian, ID

Laboratory certificates & supplier records

Derived by NPIMap

These CMS records do not include an NPI. They are shown because their name and street address match this provider’s.

CLIA laboratory certificates

CLIA numberLaboratoryCertificateExpires
13D2123706Eagle Vision One355 S Eagle Rd, Eagle, ID 83616Certificate of waiverDec 28, 2026

National Provider Directory

National Provider Directory

Locations

355 S Eagle Rd
Eagle, ID 83616
Phone (208) 938-2015

408 S Eagle Rd
Ste 100
Eagle, ID 83616
Phone (208) 939-2773

4574 N Ten Mile Rd
Ste 100
Meridian, ID 83646
Phone (208) 938-2015

Practitioners & affiliated clinicians

Practitioners 14

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

View all 14

NPI Registry JSON

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

{
    "created_epoch": "1162944000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1686787200000",
    "number": "1699845503",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "355 S EAGLE RD",
            "city": "EAGLE",
            "state": "ID",
            "postal_code": "836165912",
            "telephone_number": "208-939-2773",
            "fax_number": "208-939-5755"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "355 S EAGLE RD",
            "city": "EAGLE",
            "state": "ID",
            "postal_code": "836165912",
            "telephone_number": "208-939-2773",
            "fax_number": "208-939-5755"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "4574 N Ten Mile Rd Ste 100",
            "address_purpose": "LOCATION",
            "city": "Meridian",
            "state": "ID",
            "postal_code": "836467129",
            "country_code": "US",
            "telephone_number": "208-938-2015",
            "fax_number": "208-938-5755",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "organization_name": "EAGLE VISION ONE PLLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-11-08",
        "last_updated": "2023-06-15",
        "certification_date": "2023-06-15",
        "status": "A",
        "authorized_official_last_name": "WARNER",
        "authorized_official_first_name": "AARON",
        "authorized_official_middle_name": "J.",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "208-938-2015",
        "authorized_official_credential": "OD"
    },
    "taxonomies": [
        {
            "code": "152W00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Optometrist",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BLUE SHIELD",
            "identifier": "000010135320",
            "state": "ID"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BLUE CROSS",
            "identifier": "V4916",
            "state": "ID"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MEDICARE DMERC",
            "identifier": "5675480001",
            "state": "ID"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "806190300",
            "state": "ID"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Vision One Eagle",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Eagle, ID

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 15, 2023; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.