Provider Demographics
NPI:1992138432
Name:SUMMIT EYECARE PLLC
Entity type:Organization
Organization Name:SUMMIT EYECARE PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:TODD
Authorized Official - Middle Name:F
Authorized Official - Last Name:BIRCH
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:208-522-5594
Mailing Address - Street 1:3351 MERLIN DR
Mailing Address - Street 2:
Mailing Address - City:IDAHO FALLS
Mailing Address - State:ID
Mailing Address - Zip Code:83404-7405
Mailing Address - Country:US
Mailing Address - Phone:208-522-5594
Mailing Address - Fax:208-552-2240
Practice Address - Street 1:3351 MERLIN DR
Practice Address - Street 2:
Practice Address - City:IDAHO FALLS
Practice Address - State:ID
Practice Address - Zip Code:83404-7405
Practice Address - Country:US
Practice Address - Phone:208-522-5594
Practice Address - Fax:208-552-2240
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-08-20
Last Update Date:2013-08-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty