Provider Demographics
NPI:1548405327
Name:EYE CARE FOR YOU LLC
Entity Type:Organization
Organization Name:EYE CARE FOR YOU LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:PHILIP
Authorized Official - Middle Name:
Authorized Official - Last Name:CROMWELL
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:208-852-3030
Mailing Address - Street 1:134 N STATE ST
Mailing Address - Street 2:SUITE A
Mailing Address - City:PRESTON
Mailing Address - State:ID
Mailing Address - Zip Code:83263-1143
Mailing Address - Country:US
Mailing Address - Phone:208-852-3030
Mailing Address - Fax:208-852-3031
Practice Address - Street 1:134 N STATE ST
Practice Address - Street 2:SUITE A
Practice Address - City:PRESTON
Practice Address - State:ID
Practice Address - Zip Code:83263-1143
Practice Address - Country:US
Practice Address - Phone:208-852-3030
Practice Address - Fax:208-852-3031
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-12-09
Last Update Date:2022-10-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IDODP607152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
ID6346960001Medicare NSC
ID1370130Medicare PIN