NPIMap

Organization Active NPI

Hollingshead Eye Center, PC

  • Ophthalmology Physician
  • Boise, ID
National Provider Identifier
1871643585
Registry record updated Jun 29, 2010
On this page

Key facts

NPPES NPI Registry
Primary specialty
Ophthalmology PhysicianTaxonomy code 207W00000X
License
M6436 Issued in ID
Legal business name
HOLLINGSHEAD EYE CENTER, PC
Practice address
360 E Mallard Dr
Suite 110
Boise, ID 83706-6644
Phone
(208) 336-8700
Fax
(208) 426-0902
NPI assigned
Jan 12, 2007
Last updated
Jun 29, 2010By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jun 29, 2010

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

Authorized official

Name
Louis M Pennow, MBA
Title
Director
Phone
(208) 336-8700

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Optometrist 152W00000X ODP100159 ID
Ophthalmology Physician 207W00000X M6436 ID Primary

Addresses

Primary practice location

360 E Mallard Dr
Suite 110
Boise, ID 83706-6644

Mailing address

360 E Mallard Dr
Suite 110
Boise, ID 83706-6644
Phone (208) 336-8700

Other identifiers 2

IdentifierTypeStateIssuer
805858500MedicaidID
805858400MedicaidID

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in ID, OR2 enrollments

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
O20050616000317 ID Part B Supplier - Clinic/Group Practice 9830133214 Receives reassigned benefits from 7 practitioners
Practice locations: Boise, ID; Nampa, ID
O20120510000613 OR Part B Supplier - Clinic/Group Practice 9830133214 Practice locations: Ontario, OR

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
13D2059932Hollingshead Eye Center PC360 E Mallard Dr #110, Boise, ID 83706Certificate of waiverJun 3, 2027

National Provider Directory

National Provider Directory

Locations

360 E Mallard Dr
Boise, ID 83706

310 2nd St S
Nampa, ID 83651
Phone (208) 336-8700

Practitioners & affiliated clinicians

Practitioners 20

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.

View all 20

NPI Registry JSON

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

{
    "created_epoch": "1168560000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1277769600000",
    "number": "1871643585",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "360 E MALLARD DR",
            "address_2": "SUITE 110",
            "city": "BOISE",
            "state": "ID",
            "postal_code": "837066644",
            "telephone_number": "208-336-8700",
            "fax_number": "208-426-0902"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "360 E MALLARD DR",
            "address_2": "SUITE 110",
            "city": "BOISE",
            "state": "ID",
            "postal_code": "837066644",
            "telephone_number": "208-336-8700",
            "fax_number": "208-426-0902"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "HOLLINGSHEAD EYE CENTER, PC",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-01-12",
        "last_updated": "2010-06-29",
        "status": "A",
        "authorized_official_last_name": "PENNOW",
        "authorized_official_first_name": "LOUIS",
        "authorized_official_middle_name": "M",
        "authorized_official_title_or_position": "DIRECTOR",
        "authorized_official_telephone_number": "208-336-8700",
        "authorized_official_credential": "MBA"
    },
    "taxonomies": [
        {
            "code": "152W00000X",
            "taxonomy_group": "",
            "desc": "Optometrist",
            "state": "ID",
            "license": "ODP100159",
            "primary": false
        },
        {
            "code": "207W00000X",
            "taxonomy_group": "",
            "desc": "Ophthalmology",
            "state": "ID",
            "license": "M6436",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "805858500",
            "state": "ID"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "805858400",
            "state": "ID"
        }
    ],
    "endpoints": [],
    "other_names": []
}

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 Jun 29, 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.