Provider Demographics
NPI:1619043155
Name:VISION ONE MCCALL INC
Entity Type:Organization
Organization Name:VISION ONE MCCALL INC
Other - Org Name:VISION ONE MCCALL
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:RANDY
Authorized Official - Middle Name:
Authorized Official - Last Name:ANDREGG
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:208-634-2020
Mailing Address - Street 1:PO BOX 3030
Mailing Address - Street 2:
Mailing Address - City:MCCALL
Mailing Address - State:ID
Mailing Address - Zip Code:83638-3030
Mailing Address - Country:US
Mailing Address - Phone:208-634-2020
Mailing Address - Fax:208-634-7066
Practice Address - Street 1:313 DEINHARD LANE
Practice Address - Street 2:
Practice Address - City:MCCALL
Practice Address - State:ID
Practice Address - Zip Code:83638-3030
Practice Address - Country:US
Practice Address - Phone:208-634-2020
Practice Address - Fax:208-634-7066
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-27
Last Update Date:2008-01-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
ID000010144122OtherBLUESHIELD
IDV3785OtherBLUE CROSS
ID000010144122OtherBLUESHIELD
IDV3785OtherBLUE CROSS