Provider Demographics
NPI:1568654861
Name:ADVANTAGE EYE CENTERS INC.
Entity Type:Organization
Organization Name:ADVANTAGE EYE CENTERS INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:INSURANCE ADMINISTRATION
Authorized Official - Prefix:
Authorized Official - First Name:JAYME
Authorized Official - Middle Name:L
Authorized Official - Last Name:OWENS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:208-552-7323
Mailing Address - Street 1:2550 S 25TH E
Mailing Address - Street 2:
Mailing Address - City:IDAHO FALLS
Mailing Address - State:ID
Mailing Address - Zip Code:83404-6507
Mailing Address - Country:US
Mailing Address - Phone:208-552-7323
Mailing Address - Fax:208-552-7325
Practice Address - Street 1:2550 S 25TH E
Practice Address - Street 2:
Practice Address - City:IDAHO FALLS
Practice Address - State:ID
Practice Address - Zip Code:83404-6507
Practice Address - Country:US
Practice Address - Phone:208-552-7323
Practice Address - Fax:208-552-7325
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-08-10
Last Update Date:2016-02-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ID0818261QS0132X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QS0132XAmbulatory Health Care FacilitiesClinic/CenterOphthalmologic Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
ID1307550001OtherNORIDIAN
ID410048068OtherRAILROAD MEDICARE
ID004321400Medicaid
ID000010015407OtherREGENCE BLUESHIELD OF ID
ID1307550001OtherNORIDIAN
ID1307550001Medicare NSC