Individual provider Active NPI

Jonathan Paul Norris, O.D.

  • Optometrist
  • Mountain Home, ID
National Provider Identifier
1770748873
Registry record updated Apr 10, 2015
On this page

Key facts

NPPES NPI Registry
Primary specialty
OptometristTaxonomy code 152W00000X
License
ODP-100171 Issued in ID
Practice address
265 N 3Rd E
Mountain Home, ID 83647-2734
Phone
(208) 587-8415
Fax
(208) 587-8416
NPI assigned
Jul 28, 2008
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Apr 10, 2015

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Optometrist 152W00000X ODP-100171 ID Primary

Addresses

Primary practice location

265 N 3Rd E
Mountain Home, ID 83647-2734

Mailing address

PO Box 39
Mountain Home, ID 83647-0039
Phone (208) 587-8415

Other identifiers 1

IdentifierTypeStateIssuer
808220800MedicaidID

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in ID
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: Yes
  • Power mobility devices: No
  • Hospice: Yes
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20141229000498 ID Practitioner - Optometry 7517289317 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Optometry
Education
Ohio State University - College of Optometry, 2007
Medicare assignment
Accepts the Medicare-approved amount as payment in full

Practice addresses (Care Compare)

265 N 3Rd
Mountain Home, ID 83647-2734
Phone (208) 587-8415

Procedures performed for Medicare patients

ProcedureNumber of procedures
Cataract surgery35

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
ODP-100171IDMDOptometrist

Practice roles

OrganizationSpecialtyStatusNew patients
Norris Eye Care LLC Optometrist CurrentSince Oct 14, 2014 Accepting new patients
JFK Vision PLLC Optometrist CurrentSince Dec 15, 2014 Accepting new patients

Locations

265 N 3rd E
Mountain Home, ID 83647
Phone (208) 251-8669

Organizations & group practices 2

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

NPI Registry JSON

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

{
    "created_epoch": "1217203200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1428624000000",
    "number": "1770748873",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 39",
            "city": "MOUNTAIN HOME",
            "state": "ID",
            "postal_code": "836470039",
            "telephone_number": "208-587-8415",
            "fax_number": "208-587-8416"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "265 N 3RD E",
            "city": "MOUNTAIN HOME",
            "state": "ID",
            "postal_code": "836472734",
            "telephone_number": "208-587-8415",
            "fax_number": "208-587-8416"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "NORRIS",
        "first_name": "JONATHAN",
        "middle_name": "PAUL",
        "name_prefix": "Dr.",
        "credential": "O.D.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2008-07-28",
        "last_updated": "2015-04-10",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "152W00000X",
            "taxonomy_group": "",
            "desc": "Optometrist",
            "state": "ID",
            "license": "ODP-100171",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "808220800",
            "state": "ID"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Mountain Home, ID

Sources for this page

Verify at the official NPI Registry.