Individual provider Active NPI

Adam Heiner, O.D.

  • Optometrist
  • Eagle, ID
National Provider Identifier
1992792469
Registry record updated Apr 1, 2021
On this page

Key facts

NPPES NPI Registry
Primary specialty
OptometristTaxonomy code 152W00000X
License
ODP 1041 Issued in ID
Practice address
3541 W Bavaria St
Eagle, ID 83616-6318
Phone
(208) 939-5005
Fax
(208) 939-2496
NPI assigned
Sep 30, 2005
Last updated
Apr 1, 2021By the provider in NPPES
Sex
Male
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Apr 1, 2021

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Optometrist 152W00000X ODP 1041 ID Primary

Addresses

Primary practice location

3541 W Bavaria St
Eagle, ID 83616-6318

Mailing address

3541 W Bavaria St
Eagle, ID 83616-6318
Phone (208) 939-5005

Other identifiers 1

IdentifierTypeStateIssuer
806965200MedicaidID

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in ID
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: Yes
  • Power mobility devices: No
  • Hospice: Yes
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20050121000292 ID Practitioner - Optometry 3274582796 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Optometry
Education
Pacific University - College of Optometry, 2000
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Adams Eyecare IncGroup PAC ID 5991940850, 2 clinicians

Practice addresses (Care Compare)

2103 N Cassia St
Nampa, ID 83651-1461

3541 W Bavaria St
Eagle, ID 83616-6318

Procedures performed for Medicare patients

ProcedureNumber of procedures
Cataract surgery1-10

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
ODP 1041IDMDOptometrist

Practice roles

OrganizationSpecialtyStatusNew patients
Adams Eyecare Inc Optometrist CurrentSince Apr 1, 2013 Accepting new patients

Locations

3541 W Bavaria St
Eagle, ID 83616
Phone (208) 939-5005

2103 N Cassia St
Nampa, ID 83651
Phone (208) 465-0088

Organizations & group practices 1

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

NPI Registry JSON

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

{
    "created_epoch": "1128038400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1617235200000",
    "number": "1992792469",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3541 W BAVARIA ST",
            "city": "EAGLE",
            "state": "ID",
            "postal_code": "836166318",
            "telephone_number": "208-939-5005",
            "fax_number": "208-939-2496"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3541 W BAVARIA ST",
            "city": "EAGLE",
            "state": "ID",
            "postal_code": "836166318",
            "telephone_number": "208-939-5005",
            "fax_number": "208-939-2496"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "HEINER",
        "first_name": "ADAM",
        "name_prefix": "Dr.",
        "credential": "O.D.",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2005-09-30",
        "last_updated": "2021-04-01",
        "certification_date": "2021-04-01",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "152W00000X",
            "taxonomy_group": "",
            "desc": "Optometrist",
            "state": "ID",
            "license": "ODP 1041",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "806965200",
            "state": "ID"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Eagle, ID

Sources for this page

Verify at the official NPI Registry.