Provider Demographics
NPI:1285705772
Name:NIELSON EYECARE PROFESSIONALS PC
Entity type:Organization
Organization Name:NIELSON EYECARE PROFESSIONALS PC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:BILLING COORDINATOR
Authorized Official - Prefix:
Authorized Official - First Name:APRIL
Authorized Official - Middle Name:
Authorized Official - Last Name:MORRISON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:208-898-0304
Mailing Address - Street 1:2320 E GALA ST
Mailing Address - Street 2:SUITE 400
Mailing Address - City:MERIDIAN
Mailing Address - State:ID
Mailing Address - Zip Code:83642-7091
Mailing Address - Country:US
Mailing Address - Phone:208-898-0304
Mailing Address - Fax:208-898-0380
Practice Address - Street 1:1715 S WELLS AVE
Practice Address - Street 2:
Practice Address - City:MERIDIAN
Practice Address - State:ID
Practice Address - Zip Code:83642-5756
Practice Address - Country:US
Practice Address - Phone:208-898-0304
Practice Address - Fax:208-898-0380
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-13
Last Update Date:2024-09-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IDODP100015152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
ID51385OtherDAVIS VISION
IDV6945OtherBLUE CROSS
IDNE29102OtherSPECTERA
ID51385OtherDAVIS VISION
6208540001Medicare NSC