Provider Demographics
NPI:1114901535
Name:ALAMEDA VISION INC.
Entity Type:Organization
Organization Name:ALAMEDA VISION INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:BILLING MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:JANECE
Authorized Official - Middle Name:
Authorized Official - Last Name:FOWERS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:208-233-2020
Mailing Address - Street 1:1155 POCATELLO CREEK RD
Mailing Address - Street 2:
Mailing Address - City:POCATELLO
Mailing Address - State:ID
Mailing Address - Zip Code:83201-2949
Mailing Address - Country:US
Mailing Address - Phone:208-233-2020
Mailing Address - Fax:208-233-2021
Practice Address - Street 1:1155 POCATELLO CREEK RD
Practice Address - Street 2:
Practice Address - City:POCATELLO
Practice Address - State:ID
Practice Address - Zip Code:83201-2949
Practice Address - Country:US
Practice Address - Phone:208-233-2020
Practice Address - Fax:208-233-2021
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-11-30
Last Update Date:2011-08-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
U2498OtherBC
82413OtherBS
IDCP9184OtherRR MEDICARE
ID1591031Medicare PIN
ID0581440001Medicare NSC
ID1590018Medicare PIN
U2498OtherBC
82413OtherBS