Provider Demographics
NPI:1083209951
Name:ENVISION SPECIALTY EYECARE AND DRY EYE CENTER PLLC
Entity Type:Organization
Organization Name:ENVISION SPECIALTY EYECARE AND DRY EYE CENTER PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/MANAGER
Authorized Official - Prefix:DR
Authorized Official - First Name:JASON
Authorized Official - Middle Name:ROBERT
Authorized Official - Last Name:BESECKER
Authorized Official - Suffix:
Authorized Official - Credentials:OD, MS
Authorized Official - Phone:208-490-8823
Mailing Address - Street 1:1130 E FAIRVIEW AVE
Mailing Address - Street 2:
Mailing Address - City:MERIDIAN
Mailing Address - State:ID
Mailing Address - Zip Code:83642-1813
Mailing Address - Country:US
Mailing Address - Phone:208-490-8823
Mailing Address - Fax:
Practice Address - Street 1:1130 E FAIRVIEW AVE
Practice Address - Street 2:
Practice Address - City:MERIDIAN
Practice Address - State:ID
Practice Address - Zip Code:83642-1813
Practice Address - Country:US
Practice Address - Phone:208-859-5125
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-03-03
Last Update Date:2021-07-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
ID000010000322OtherBLUE SHIELD