NPIMap

Organization Active NPI

Boise Mountain Eye Associates, PLLC

  • Optometrist
  • Boise, ID
National Provider Identifier
1902007263
Registry record updated Jun 4, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
OptometristTaxonomy code 152W00000X
License
ODP-1022 Issued in ID
Legal business name
BOISE MOUNTAIN EYE ASSOCIATES, PLLC
Practice address
13075 Persimmon LN., Suite a
Boise, ID 83713-2078
Phone
(208) 938-9900
Fax
(208) 939-9264
NPI assigned
May 31, 2007
Organization subpart
No

Authorized official

NPPES NPI Registry
Name
Dr. Todd A Stebel, O.D.NPI 1144263963
Title
Owner
Phone
(208) 938-9900

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Practitioners 5

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

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20071227000576 ID Part B Supplier - Clinic/Group Practice 7012097348 Receives reassigned benefits from 4 practitioners
Practice locations: Boise, ID

National Provider Directory

National Provider Directory

Locations

13075 W Persimmon Ln
#110
Boise, ID 83713
Phone (208) 938-9900

13075 W Persimmon Ln
Ste A
Boise, ID 83713
Phone (208) 938-9900

Specialties & licenses 2

NPPES NPI Registry
Specialty (taxonomy)CodeLicenseStatePrimary
OptometristGroup: 193400000X MULTIPLE SINGLE SPECIALTY GROUP 152W00000X ODP-1022 ID Primary
OptometristGroup: 193400000X MULTIPLE SINGLE SPECIALTY GROUP 152W00000X ODP-1027 ID

Addresses

NPPES NPI Registry

Primary practice location

13075 Persimmon LN., Suite a
Boise, ID 83713-2078

Mailing address

13075 Persimmon LN., Suite a
Boise, ID 83713-2078
Phone (208) 938-9900

Other names 1

NPPES NPI Registry
  • Boise Mountain Eyecare Doing business as

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format, last updated by the provider on Jun 4, 2024.

{
    "created_epoch": "1180569600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1717459200000",
    "number": "1902007263",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "13075 PERSIMMON LN., SUITE A",
            "city": "BOISE",
            "state": "ID",
            "postal_code": "837132078",
            "telephone_number": "208-938-9900",
            "fax_number": "208-939-9264"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "13075 PERSIMMON LN., SUITE A",
            "city": "BOISE",
            "state": "ID",
            "postal_code": "837132078",
            "telephone_number": "208-938-9900",
            "fax_number": "208-939-9264"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "BOISE MOUNTAIN EYE ASSOCIATES, PLLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-05-31",
        "last_updated": "2024-06-04",
        "certification_date": "2024-06-04",
        "status": "A",
        "authorized_official_last_name": "STEBEL",
        "authorized_official_first_name": "TODD",
        "authorized_official_middle_name": "A",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "208-938-9900",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "O.D."
    },
    "taxonomies": [
        {
            "code": "152W00000X",
            "taxonomy_group": "193400000X MULTIPLE SINGLE SPECIALTY GROUP",
            "desc": "Optometrist",
            "state": "ID",
            "license": "ODP-1022",
            "primary": true
        },
        {
            "code": "152W00000X",
            "taxonomy_group": "193400000X MULTIPLE SINGLE SPECIALTY GROUP",
            "desc": "Optometrist",
            "state": "ID",
            "license": "ODP-1027",
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Boise Mountain Eyecare",
            "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 Jun 4, 2024; 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.