NPIMap

Organization Active NPI

Hayden Vision Source PLLC

  • Optometrist
  • Hayden, ID
National Provider Identifier
1780345264
Registry record updated Jul 6, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
OptometristTaxonomy code 152W00000X
Legal business name
HAYDEN VISION SOURCE PLLC
Practice address
8445 N Government Way
Hayden, ID 83835-9349
Phone
(208) 772-3208
Fax
(208) 762-2574
NPI assigned
Jan 6, 2022
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jul 6, 2022

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

Authorized official

Name
Tyrel Bruneel, ODNPI 1013575851
Title
Owner
Phone
(208) 772-3208

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

8445 N Government Way
Hayden, ID 83835-9349

Mailing address

8445 N Government Way
Hayden, ID 83835-9349
Phone (208) 772-3208

National Provider Directory

National Provider Directory
Tax ID family
Hayden Vision Source2 organizations share this tax ID, including this one

Other organizations with this tax ID 1

Organizations that report the same tax identification number in the National Provider Directory.

Practitioners & affiliated clinicians

Practitioners 1

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": "1641427200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1657065600000",
    "number": "1780345264",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "8445 N GOVERNMENT WAY",
            "city": "HAYDEN",
            "state": "ID",
            "postal_code": "838359349",
            "telephone_number": "208-772-3208",
            "fax_number": "208-762-2574"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "8445 N GOVERNMENT WAY",
            "city": "HAYDEN",
            "state": "ID",
            "postal_code": "838359349",
            "telephone_number": "208-772-3208",
            "fax_number": "208-762-2574"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "HAYDEN VISION SOURCE PLLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2022-01-06",
        "last_updated": "2022-07-06",
        "certification_date": "2022-07-06",
        "status": "A",
        "authorized_official_last_name": "BRUNEEL",
        "authorized_official_first_name": "TYREL",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "208-772-3208",
        "authorized_official_credential": "OD"
    },
    "taxonomies": [
        {
            "code": "152W00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Optometrist",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Hayden, ID

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 6, 2022; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.