Provider Demographics
NPI:1649236571
Name:EYECARE ASSOCIATES OF COLE VILLAGE, P.A.
Entity Type:Organization
Organization Name:EYECARE ASSOCIATES OF COLE VILLAGE, P.A.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/DOCTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:JAMES
Authorized Official - Middle Name:W
Authorized Official - Last Name:VAIL
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:208-377-1102
Mailing Address - Street 1:3417 N COLE RD
Mailing Address - Street 2:
Mailing Address - City:BOISE
Mailing Address - State:ID
Mailing Address - Zip Code:83704-4406
Mailing Address - Country:US
Mailing Address - Phone:208-377-1102
Mailing Address - Fax:208-377-5853
Practice Address - Street 1:3417 N COLE RD
Practice Address - Street 2:
Practice Address - City:BOISE
Practice Address - State:ID
Practice Address - Zip Code:83704-4406
Practice Address - Country:US
Practice Address - Phone:208-377-1102
Practice Address - Fax:208-377-5853
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-04-20
Last Update Date:2008-02-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IDODP524152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
ID15912602Medicare PIN
ID1214630001Medicare ID - Type Unspecified