Provider Demographics
NPI:1124729835
Name:ELEVATE EYE CARE PLLC
Entity type:Organization
Organization Name:ELEVATE EYE CARE PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:JAMIE
Authorized Official - Middle Name:N
Authorized Official - Last Name:RODRIGUEZ
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:405-246-5062
Mailing Address - Street 1:404 E PARKCENTER BLVD STE 170
Mailing Address - Street 2:
Mailing Address - City:BOISE
Mailing Address - State:ID
Mailing Address - Zip Code:83706-7564
Mailing Address - Country:US
Mailing Address - Phone:208-210-4832
Mailing Address - Fax:208-210-4833
Practice Address - Street 1:404 E PARKCENTER BLVD STE 170
Practice Address - Street 2:
Practice Address - City:BOISE
Practice Address - State:ID
Practice Address - Zip Code:83706-7564
Practice Address - Country:US
Practice Address - Phone:208-210-4832
Practice Address - Fax:208-210-4833
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-03-10
Last Update Date:2023-03-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty