Organization
ADVANTAGE EYE CENTERS INC.
Active
Organization subpart
No
Provider details
NPI number
Authorized official
JAYME L OWENS (INSURANCE ADMINISTRATION)
(208) 552-7323
Entity
Organization
Contact information
Practice address
2550 S 25TH E, IDAHO FALLS, ID 83404-6507
(208) 552-7323
(208) 552-7325
Mailing address
2550 S 25TH E, IDAHO FALLS, ID 83404-6507
(208) 552-7323
(208) 552-7325
Taxonomy
Speciality
Code
Description
License number
State
261QS0132X
Ophthalmologic Surgery Clinic/Center
Primary
0818
ID
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
000010015407
REGENCE BLUESHIELD OF ID
ID
05
—
004321400
—
ID
01
—
1307550001
NORIDIAN
ID
01
—
410048068
RAILROAD MEDICARE
ID
Enumeration date
08/10/2007
Last updated
02/05/2016
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