Provider Demographics
NPI:1598940421
Name:TREE CITY EYECARE PLLC
Entity Type:Organization
Organization Name:TREE CITY EYECARE PLLC
Other - Org Name:OPTOMETRIC CENTER, P.A.
Other - Org Type:Former Legal Business Name
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:JAIMEN
Authorized Official - Middle Name:
Authorized Official - Last Name:DIXON
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:208-375-3871
Mailing Address - Street 1:700 N RAYMOND ST
Mailing Address - Street 2:
Mailing Address - City:BOISE
Mailing Address - State:ID
Mailing Address - Zip Code:83704-9261
Mailing Address - Country:US
Mailing Address - Phone:208-375-3871
Mailing Address - Fax:208-321-1765
Practice Address - Street 1:700 N RAYMOND ST
Practice Address - Street 2:
Practice Address - City:BOISE
Practice Address - State:ID
Practice Address - Zip Code:83704-9261
Practice Address - Country:US
Practice Address - Phone:208-375-3871
Practice Address - Fax:208-321-1765
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-01-09
Last Update Date:2023-08-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Multi-Specialty
No152WC0802XEye and Vision Services ProvidersOptometristCorneal and Contact ManagementGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
ID20015736OtherMEDICARE ID
ID15989404214Medicaid
1592059Medicare PIN