Provider Demographics
NPI:1194920421
Name:VALLEY VISION CARE, P.A.
Entity type:Organization
Organization Name:VALLEY VISION CARE, P.A.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:WILLIAM
Authorized Official - Middle Name:ERNEST
Authorized Official - Last Name:FAURE
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:208-322-1771
Mailing Address - Street 1:10480 GARVERDALE CT
Mailing Address - Street 2:STE 806
Mailing Address - City:BOISE
Mailing Address - State:ID
Mailing Address - Zip Code:83704
Mailing Address - Country:US
Mailing Address - Phone:208-322-1771
Mailing Address - Fax:208-377-9703
Practice Address - Street 1:10480 GARVERDALE CT
Practice Address - Street 2:STE 806
Practice Address - City:BOISE
Practice Address - State:ID
Practice Address - Zip Code:83704
Practice Address - Country:US
Practice Address - Phone:208-322-1771
Practice Address - Fax:208-377-9703
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-06-18
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IDV3660OtherBLUE CROSS
ID1368684Medicare ID - Type Unspecified