Active NPI
Eyecenter PA
- Optometrist
- Jerome, ID
National Provider Identifier
1699862805
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Optometrist
- Legal business name
- EYECENTER PA
- Practice address
- 201 South Lincoln
Jerome, ID 83338-2624 - Phone
- (208) 324-4363
- Fax
- (208) 324-8948
- NPI assigned
- Oct 7, 2006
- Organization subpart
- Yes
- Parent organization
- EYECENTER PA
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Authorized official
- Name
- James A Davis, OD
- Title
- Owner Optometrist
- Phone
- (208) 324-4363
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Optometrist | 152W00000X | Primary |
Addresses
Primary practice location
201 South Lincoln
Jerome, ID 83338-2624
Mailing address
201 South Lincoln
Jerome, ID 83338-2624
Phone (208) 324-4363
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| CP7637 | Other | TRAVELERS RR MEDICARE GRP |
Other names 1
- Jerome Eyecenter
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Enrolled in ID
Enrollment records 1
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| O20051107001076 | ID | Part B Supplier - Clinic/Group Practice | 4486672565 |
Receives reassigned benefits from 5 practitioners 3 other NPIs on this enrollment This NPI is an additional NPI on the enrollment Practice locations: Ketchum, ID; Twin Falls, ID; Jerome, ID; Hailey, ID |
Other NPIs on the same Medicare enrollment 3
NPIs listed together on one Medicare enrollment, typically parts of the same organization.
National Provider Directory
National Provider Directory- Part of
- The Eyecenter PA
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1160179200000",
"enumeration_type": "NPI-2",
"last_updated_epoch": "1199750400000",
"number": "1699862805",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "201 SOUTH LINCOLN",
"city": "JEROME",
"state": "ID",
"postal_code": "833382624",
"telephone_number": "208-324-4363",
"fax_number": "208-324-8948"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "201 SOUTH LINCOLN",
"city": "JEROME",
"state": "ID",
"postal_code": "833382624",
"telephone_number": "208-324-4363",
"fax_number": "208-324-8948"
}
],
"practiceLocations": [],
"basic": {
"organization_name": "EYECENTER PA",
"organizational_subpart": "YES",
"parent_organization_legal_business_name": "EYECENTER PA",
"enumeration_date": "2006-10-07",
"last_updated": "2008-01-08",
"status": "A",
"authorized_official_last_name": "DAVIS",
"authorized_official_first_name": "JAMES",
"authorized_official_middle_name": "A",
"authorized_official_title_or_position": "OWNER OPTOMETRIST",
"authorized_official_telephone_number": "208-324-4363",
"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": "TRAVELERS RR MEDICARE GRP",
"identifier": "CP7637",
"state": null
}
],
"endpoints": [],
"other_names": [
{
"organization_name": "Jerome Eyecenter",
"code": "3",
"type": "Doing Business As"
}
]
}Other providers in Jerome, ID
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 8, 2008; 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.