Active NPI
Ivie Family Vision PA
- Optometrist
- Idaho Falls, ID
National Provider Identifier
1992114615
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Optometrist
- License
- ODP100241
- Legal business name
- IVIE FAMILY VISION PA
- Practice address
- 2405 Jafer CT
Idaho Falls, ID 83404-5587 - Phone
- (208) 529-2700
- Fax
- (208) 529-0873
- NPI assigned
- Aug 6, 2014
- Organization subpart
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Authorized official
- Name
- Dr. Jared Reese Ivie, O.D.
- Title
- Owner/Optometrist
- Phone
- (208) 529-2700
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) | Code | License | State | Primary |
|---|---|---|---|---|
| Optometrist | 152W00000X | ODP100241 | ID | Primary |
Addresses
Primary practice location
2405 Jafer CT
Idaho Falls, ID 83404-5587
Mailing address
2405 Jafer CT
Idaho Falls, ID 83404-5587
Phone (208) 529-2700
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1285852599 | Medicaid | ID |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Enrolled in ID
Enrollment records 1
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| O20150205001453 | ID | Part B Supplier - Clinic/Group Practice | 2163747551 |
Receives reassigned benefits from 3 practitioners Practice locations: Idaho Falls, ID |
National Provider Directory
National Provider DirectoryLocations
2540 Channing Way
Idaho Falls, ID 83404
Phone (208) 523-1980
Practitioners & affiliated clinicians
Practitioners 3
Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1407283200000",
"enumeration_type": "NPI-2",
"last_updated_epoch": "1687305600000",
"number": "1992114615",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "2405 JAFER CT",
"city": "IDAHO FALLS",
"state": "ID",
"postal_code": "834045587",
"telephone_number": "208-529-2700",
"fax_number": "208-529-0873"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "2405 JAFER CT",
"city": "IDAHO FALLS",
"state": "ID",
"postal_code": "834045587",
"telephone_number": "208-529-2700",
"fax_number": "208-529-0873"
}
],
"practiceLocations": [],
"basic": {
"organization_name": "IVIE FAMILY VISION PA",
"organizational_subpart": "NO",
"enumeration_date": "2014-08-06",
"last_updated": "2023-06-21",
"certification_date": "2023-06-21",
"status": "A",
"authorized_official_last_name": "IVIE",
"authorized_official_first_name": "JARED",
"authorized_official_middle_name": "REESE",
"authorized_official_title_or_position": "OWNER/OPTOMETRIST",
"authorized_official_telephone_number": "208-529-2700",
"authorized_official_name_prefix": "Dr.",
"authorized_official_credential": "O.D."
},
"taxonomies": [
{
"code": "152W00000X",
"taxonomy_group": "193400000X SINGLE SPECIALTY GROUP",
"desc": "Optometrist",
"state": "ID",
"license": "ODP100241",
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "1285852599",
"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 Jun 21, 2023; 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.