Eye Care for You
Organization Active NPI Optometrist · Sandpoint, ID
NPI 1710042353 · NPPES record last updated Jun 23, 2008
Key facts
- NPI
- 1710042353
- Entity type
- Organization (NPI type 2)
- Primary specialty
- Optometrist 152W00000X
- License
- ODP895 (ID)
- Legal business name
- EYE CARE FOR YOU
- Practice address
- 710 W. Superior St.
Ste a
Sandpoint, ID 83864 - Phone
- (208) 263-9000
- Fax
- (208) 263-9589
- NPI assigned
- Dec 26, 2006
- Organization subpart
- No
Authorized official
- Name
- Dr. Julie Beth Gagnon, OD
- Title
- Owner President
- Phone
- (208) 263-9000
Practitioners 12
-
Jeremiah Gagnon, OD
-
Andrea Moore, O.D.
-
Amber Dawn Prins, OD
-
Chad Louis Schobert, O.D.
-
Alisha M Heaton, OD
-
Rupert C Chowins, O.D.
-
Jeffrey L Cromwell, O.D.
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in ID
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| O20051129000484 | ID | Part B Supplier - Clinic/Group Practice | 5395765853 |
Receives reassigned benefits from 5 practitioners Practice locations: Sandpoint, ID |
National Provider Directory
Locations
312 N 4th St
Coeur D Alene, ID 83814
Phone (208) 676-1422
710 W Superior St
Sandpoint, ID 83864
710 W Superior St
Ste A
Sandpoint, ID 83864
Phone (208) 263-9000
1300 N 200 E
Ste 104
Logan, UT 84341
Phone (435) 752-6453
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Optometrist |
152W00000X | ODP895 | ID | Yes |
Addresses
Primary practice location
710 W. Superior St.
Ste a
Sandpoint, ID 83864
Mailing address
710 W. Superior St.
Ste a
Sandpoint, ID 83864
Phone (208) 263-9000
Other identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| V3900 | Other | BL CROSS | |
| 0483922 | Medicaid | MT | |
| 002582600 | Medicaid | ID | |
| 000010152218 | Other | BL SHIELD |
Other names
- Sandpoint Eyes PA
Other providers in Sandpoint, ID
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Jun 23, 2008. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.