NPIMap

Organization Active NPI

LWK, P.C.

  • Optometrist
  • Boise, ID
National Provider Identifier
1851624019
Registry record updated Feb 4, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
OptometristTaxonomy code 152W00000X
License
972 Issued in ID
Legal business name
LWK, P.C.
Practice address
291 N Milwaukee St
Suite a-3
Boise, ID 83704
Phone
(208) 378-7020
Fax
(208) 375-7970
NPI assigned
Sep 4, 2009
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Feb 4, 2020

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

Authorized official

Name
Dr. Lavar W Kofoed, ODNPI 1023231420
Title
President
Phone
(208) 378-7020

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 972 ID Primary

Addresses

Primary practice location

291 N Milwaukee St
Suite a-3
Boise, ID 83704

Mailing address

3485 N Cole Rd Unit 45479
Boise, ID 83711-1095
Phone (208) 297-7019

Other practice location 1

16448 N Midland Blvd
Nampa, ID 83687-5222
Phone (208) 297-7019

Other practice location 2

1605 Blue Lakes Blvd N Ste A
Twin Falls, ID 83301-3322
Phone (208) 297-7019

Other practice location 3

4013 Yellowstone Ave Ste D
Chubbuck, ID 83202-1984
Phone (208) 297-7019

Other names 2

  • Eye Pros Doing business as
  • Idaho Eye Pros Doing business as

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in ID

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20100524000915 ID Part B Supplier - Clinic/Group Practice 5890824247 Receives reassigned benefits from 24 practitioners
Practice locations: Boise, ID; Chubbuck, ID; Nampa, ID; Twin Falls, ID

National Provider Directory

National Provider Directory

Member organizations 2

Organizations listed as members of this organization in the National Provider Directory.

Locations

6128 W Fairview Ave
Ste 2A
Boise, ID 83704
Phone (208) 378-7020

291 N Milwaukee St
Ste A
Boise, ID 83704

291 N Milwaukee St
Boise, ID 83704
Phone (208) 378-7020

16448 N Midland Blvd
Nampa, ID 83687
Phone (208) 467-7020

4013 Yellowstone Ave
Ste D
Pocatello, ID 83202
Phone (208) 297-7019

Practitioners & affiliated clinicians

Practitioners 24

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

View all 24

NPI Registry JSON

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

{
    "created_epoch": "1252022400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1580774400000",
    "number": "1851624019",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3485 N COLE RD UNIT 45479",
            "city": "BOISE",
            "state": "ID",
            "postal_code": "837111095",
            "telephone_number": "208-297-7019",
            "fax_number": "208-297-7518"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "291 N MILWAUKEE ST",
            "address_2": "SUITE A-3",
            "city": "BOISE",
            "state": "ID",
            "postal_code": "83704",
            "telephone_number": "208-378-7020",
            "fax_number": "208-375-7970"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "16448 N Midland Blvd",
            "address_purpose": "LOCATION",
            "city": "Nampa",
            "state": "ID",
            "postal_code": "836875222",
            "country_code": "US",
            "telephone_number": "208-297-7019",
            "fax_number": "208-297-7518",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "1605 Blue Lakes Blvd N Ste A",
            "address_purpose": "LOCATION",
            "city": "Twin Falls",
            "state": "ID",
            "postal_code": "833013322",
            "country_code": "US",
            "telephone_number": "208-297-7019",
            "fax_number": "208-297-7518",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "4013 Yellowstone Ave Ste D",
            "address_purpose": "LOCATION",
            "city": "Chubbuck",
            "state": "ID",
            "postal_code": "832021984",
            "country_code": "US",
            "telephone_number": "208-297-7019",
            "fax_number": "208-297-7518",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "organization_name": "LWK, P.C.",
        "organizational_subpart": "NO",
        "enumeration_date": "2009-09-04",
        "last_updated": "2020-02-04",
        "certification_date": "2020-02-04",
        "status": "A",
        "authorized_official_last_name": "KOFOED",
        "authorized_official_first_name": "LAVAR",
        "authorized_official_middle_name": "W",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "208-378-7020",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "OD"
    },
    "taxonomies": [
        {
            "code": "152W00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Optometrist",
            "state": "ID",
            "license": "972",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Eye Pros",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "Idaho Eye Pros",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "Idaho Eye Pros",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Boise, ID

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 4, 2020; 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.

Verify at the official NPI Registry.