NPIMap

Organization Active NPI

Daniel L Tiller PA

Doing business as Advanced Eyecare

  • Optometrist
  • Nampa, ID
National Provider Identifier
1861485989
Registry record updated Jan 14, 2010
On this page

Key facts

NPPES NPI Registry
Primary specialty
OptometristTaxonomy code 152W00000X
Legal business name
DANIEL L TILLER PA
Doing business as
Advanced Eyecare
Practice address
901 12TH Ave S
Nampa, ID 83651-4658
Phone
(208) 466-9251
Fax
(208) 463-1714
NPI assigned
Aug 24, 2005
Last updated
Jan 14, 2010By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jan 14, 2010

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

Authorized official

Name
Dr. Rodney L White, O.D.NPI 1487647509
Title
Owner
Phone
(208) 466-9251

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
Optometrist 152W00000X ID Primary

Addresses

Primary practice location

901 12TH Ave S
Nampa, ID 83651-4658

Mailing address

901 12TH Ave S
Nampa, ID 83651-4658
Phone (208) 466-9251

Other identifiers 2

IdentifierTypeStateIssuer
V213-4OtherIDBLUE CROSS OF IDAHO
807007400MedicaidID

Other names 1

  • Advanced Eyecare Doing business as

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in ID2 enrollments

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
O20080110000225 ID Part B Supplier - Clinic/Group Practice 3476633801 Receives reassigned benefits from 5 practitioners
Practice locations: Nampa, ID
O20100930027065 ID DME Supplier - Physician - Optometrist 3476633801 Practice locations: Nampa, ID

Laboratory certificates & supplier records

Derived by NPIMap

These CMS records do not include an NPI. They are shown because their name and street address match this provider’s.

CLIA laboratory certificates

CLIA numberLaboratoryCertificateExpires
13D2041621Advanced Eyecare901 12TH Ave S, Nampa, ID 83651Certificate of waiverMay 24, 2028

Medicare medical equipment & supply locations

SupplierSuppliesMedicare assignment
Advanced Eyecare901 12TH Ave S, Nampa, ID 83651-4658(208) 466-9251 Prosthetic Lenses: Conventional Eyeglasses|Prosthetic Lenses: Conventional Contact Lenses|Prosthetic Lenses: Prosthetics Cataract Lenses Accepts assignmentParticipating since May 19, 1998

National Provider Directory

National Provider Directory

Locations

901 12th Ave S
Nampa, ID 83651
Phone (208) 466-9251

Practitioners & affiliated clinicians

Practitioners 5

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": "1124841600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1263427200000",
    "number": "1861485989",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "901 12TH AVE S",
            "city": "NAMPA",
            "state": "ID",
            "postal_code": "836514658",
            "telephone_number": "208-466-9251",
            "fax_number": "208-463-1714"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "901 12TH AVE S",
            "city": "NAMPA",
            "state": "ID",
            "postal_code": "836514658",
            "telephone_number": "208-466-9251",
            "fax_number": "208-463-1714"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "DANIEL L TILLER PA",
        "organizational_subpart": "NO",
        "enumeration_date": "2005-08-24",
        "last_updated": "2010-01-14",
        "status": "A",
        "authorized_official_last_name": "WHITE",
        "authorized_official_first_name": "RODNEY",
        "authorized_official_middle_name": "L",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "208-466-9251",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "O.D."
    },
    "taxonomies": [
        {
            "code": "152W00000X",
            "taxonomy_group": "",
            "desc": "Optometrist",
            "state": "ID",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BLUE CROSS OF IDAHO",
            "identifier": "V213-4",
            "state": "ID"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "807007400",
            "state": "ID"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Advanced Eyecare",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Nampa, ID

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 14, 2010; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.