IDAHO EYE CENTER PA NPI 1518021849

NPI Information

  • NPI: 1518021849
  • Provider Name: IDAHO EYE CENTER PA
  • Classification: Ophthalmology - 207W00000X
  • Entity Type: Organization
  • CLIA Number: 13D0951611
  • Address: 2025 E 17TH ST
    IDAHO FALLS, ID
    ZIP 83404
  • Phone: (208) 524-2025

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NPI Details

IDAHO EYE CENTER PA is an ophthalmology in Idaho Falls, ID. The provider is an ophthalmologist has the knowledge and professional skills needed to provide comprehensive eye and vision care. Ophthalmologists are medically trained to diagnose, monitor and medically or surgically treat all ocular and visual disorders. This includes problems affecting the eye and its component structures, the eyelids, the orbit and the visual pathways. In so doing, an ophthalmologist prescribes vision services, including glasses and contact lenses. IDAHO EYE CENTER PA NPI is 1518021849. The provider is registered as an organization entity type and is a single specialty group.

The provider's business location address is:

2025 E 17TH ST
IDAHO FALLS, ID
ZIP 83404
Phone: (208) 524-2025
Fax: (208) 529-1924

The provider's authorized official is Bradley P Gardner .
The authorized official title is Senior Vice President and has the following contact phone number (208) 524-2025.

The CLIA number assigned to this NPI record is 13D0951611 - ambulatory surgery center with a certificate type of Certificate of Waiver.

The enumeration date for this NPI number is 12/21/2006 and was last updated on 8/20/2008.

Taxonomy Codes

The NPI record includes the healthcare provider taxonomy classification, state license number and state of licensure. The following information regarding the scope of practice of this provider is available:

No. Taxonomy Code Taxonomy Clasification Taxonomy Specialization License Number License State Primary
1207W00000XOphthalmologyYes

Other Identifiers

The following information regarding additional identifiers associated to this NPI record includes the other identifier number, identifier type, identifier state and issuer.

No. Other Provider Identifier Other Provider Identifier Type Other Provider Identifier State Other Provider Identifier Issuer
184434OTHERIDAHOBLUE CROSS
210006MEDICARE ID-TYPE UNSPECIFIEDWYOMING
38C626OTHERIDAHOBLUE CROSS
41373829MEDICARE ID-TYPE UNSPECIFIEDIDAHO
51373828MEDICARE ID-TYPE UNSPECIFIEDIDAHO
61592851MEDICARE PINIDAHO
78E837OTHERIDAHOBLUE CROSS
81592852MEDICARE PINIDAHO
98F876OTHERIDAHOBLUE CROSS

What is NPI?

NPI stands for National Provider Identifier. The NPI is a 10-digit identification number that is completely unique. The NPI number by itself does not contain any identifiable information such as a provider’s speciality or location. The NPI is assigned to individuals or organizacions for their lifespan and it is independent of key provider information type updates like a change of practices, location or speciality.

This page was last updated on: 11/21/2025

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