NPIMap

Organization Active NPI

Idaho Eyecare Center

  • Optometrist
  • Boise, ID
National Provider Identifier
1992899181
Registry record updated Jun 15, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
OptometristTaxonomy code 152W00000X
License
ODP-612 Issued in ID
Legal business name
IDAHO EYECARE CENTER
Practice address
1175 W Boise Ave
Boise, ID 83706-3503
Phone
(208) 384-9194
Fax
(208) 384-9327
NPI assigned
Oct 3, 2006
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jun 15, 2023

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

Authorized official

Name
John Howard Muto, O.D.NPI 1912091174
Title
President
Phone
(208) 384-9194

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
OptometristGroup: 193400000X SINGLE SPECIALTY GROUP 152W00000X ODP-612 ID Primary

Addresses

Primary practice location

1175 W Boise Ave
Boise, ID 83706-3503

Mailing address

1175 W Boise Ave
Boise, ID 83706-3503
Phone (208) 384-9194

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20100818000156 ID Part B Supplier - Clinic/Group Practice 9335105311 Receives reassigned benefits from 6 practitioners
Practice locations: Boise, ID

National Provider Directory

National Provider Directory

Locations

1175 W Boise Ave
Boise, ID 83706
Phone (208) 384-9194

Practitioners & affiliated clinicians

Practitioners 13

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

View all 13

NPI Registry JSON

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

{
    "created_epoch": "1159833600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1686787200000",
    "number": "1992899181",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1175 W BOISE AVE",
            "city": "BOISE",
            "state": "ID",
            "postal_code": "837063503",
            "telephone_number": "208-384-9194",
            "fax_number": "208-384-9327"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1175 W BOISE AVE",
            "city": "BOISE",
            "state": "ID",
            "postal_code": "837063503",
            "telephone_number": "208-384-9194",
            "fax_number": "208-384-9327"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "IDAHO EYECARE CENTER",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-10-03",
        "last_updated": "2023-06-15",
        "certification_date": "2023-06-15",
        "status": "A",
        "authorized_official_last_name": "MUTO",
        "authorized_official_first_name": "JOHN",
        "authorized_official_middle_name": "HOWARD",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "208-384-9194",
        "authorized_official_credential": "O.D."
    },
    "taxonomies": [
        {
            "code": "152W00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Optometrist",
            "state": "ID",
            "license": "ODP-612",
            "primary": true
        }
    ],
    "identifiers": [],
    "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 15, 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.

Verify at the official NPI Registry.