Provider Demographics
NPI:1710042353
Name:EYE CARE FOR YOU
Entity Type:Organization
Organization Name:EYE CARE FOR YOU
Other - Org Name:SANDPOINT EYES PA
Other - Org Type:Other Name
Authorized Official - Title/Position:OWNER PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:JULIE
Authorized Official - Middle Name:BETH
Authorized Official - Last Name:GAGNON
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:208-263-9000
Mailing Address - Street 1:710 W. SUPERIOR ST.
Mailing Address - Street 2:STE A
Mailing Address - City:SANDPOINT
Mailing Address - State:ID
Mailing Address - Zip Code:83864
Mailing Address - Country:US
Mailing Address - Phone:208-263-9000
Mailing Address - Fax:208-263-9589
Practice Address - Street 1:710 W. SUPERIOR ST.
Practice Address - Street 2:STE A
Practice Address - City:SANDPOINT
Practice Address - State:ID
Practice Address - Zip Code:83864
Practice Address - Country:US
Practice Address - Phone:208-263-9000
Practice Address - Fax:208-263-9589
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-26
Last Update Date:2008-06-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IDODP895152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
V3900OtherBL CROSS
MT0483922Medicaid
ID002582600Medicaid
000010152218OtherBL SHIELD
V3900OtherBL CROSS
1368785Medicare ID - Type Unspecified
ID002582600Medicaid