NPIMap

Organization Active NPI

Gary J Lattimore

  • Optometrist
  • Idaho Falls, ID
National Provider Identifier
1831398643
Registry record updated Feb 28, 2008
On this page

Key facts

NPPES NPI Registry
Primary specialty
OptometristTaxonomy code 152W00000X
Legal business name
GARY J LATTIMORE
Practice address
501 S Woodruff Ave
Idaho Falls, ID 83401-5200
Phone
(208) 522-6271
Fax
(208) 522-7217
NPI assigned
Jul 12, 2007
Last updated
Feb 28, 2008By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Feb 28, 2008

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

Authorized official

Name
Mr. Gary J Lattimore, O.D.NPI 1902863293
Title
Optometrist
Phone
(208) 522-6271

Authorized official NPPES reports the official by name only. The link goes to the one practitioner with that name whose NPPES practice address or phone number is this organization’s.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Optometrist 152W00000X NU Primary

Addresses

Primary practice location

501 S Woodruff Ave
Idaho Falls, ID 83401-5200

Mailing address

501 S Woodruff Ave
Idaho Falls, ID 83401-5200
Phone (208) 522-6271

Other identifiers 3

IdentifierTypeStateIssuer
V0724OtherIDBLUE CROSS OF IDAHO
002441400MedicaidIN
000010015231OtherIDBLUESHIELD OF IDAHO

National Provider Directory

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, and the practitioner matching its NPPES authorized official.

NPI Registry JSON

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

{
    "created_epoch": "1184198400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1204156800000",
    "number": "1831398643",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "501 S WOODRUFF AVE",
            "city": "IDAHO FALLS",
            "state": "ID",
            "postal_code": "834015200",
            "telephone_number": "208-522-6271",
            "fax_number": "208-522-7217"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "501 S WOODRUFF AVE",
            "city": "IDAHO FALLS",
            "state": "ID",
            "postal_code": "834015200",
            "telephone_number": "208-522-6271",
            "fax_number": "208-522-7217"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "GARY J LATTIMORE",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-07-12",
        "last_updated": "2008-02-28",
        "status": "A",
        "authorized_official_last_name": "LATTIMORE",
        "authorized_official_first_name": "GARY",
        "authorized_official_middle_name": "J",
        "authorized_official_title_or_position": "OPTOMETRIST",
        "authorized_official_telephone_number": "208-522-6271",
        "authorized_official_name_prefix": "Mr.",
        "authorized_official_credential": "O.D."
    },
    "taxonomies": [
        {
            "code": "152W00000X",
            "taxonomy_group": "",
            "desc": "Optometrist",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BLUE CROSS OF IDAHO",
            "identifier": "V0724",
            "state": "ID"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "002441400",
            "state": "IN"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BLUESHIELD OF IDAHO",
            "identifier": "000010015231",
            "state": "ID"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Idaho Falls, ID

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 28, 2008; 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.