Provider Demographics
NPI:1821168907
Name:VISION ONE INC
Entity Type:Organization
Organization Name:VISION ONE INC
Other - Org Name:VISION ONE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:GREGORY
Authorized Official - Middle Name:N
Authorized Official - Last Name:BODILY
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:208-344-2020
Mailing Address - Street 1:610 AMERICANA BLVD
Mailing Address - Street 2:
Mailing Address - City:BOISE
Mailing Address - State:ID
Mailing Address - Zip Code:83702-6731
Mailing Address - Country:US
Mailing Address - Phone:208-344-2020
Mailing Address - Fax:208-344-2371
Practice Address - Street 1:610 AMERICANA BLVD
Practice Address - Street 2:
Practice Address - City:BOISE
Practice Address - State:ID
Practice Address - Zip Code:83702-6731
Practice Address - Country:US
Practice Address - Phone:208-344-2020
Practice Address - Fax:208-344-2371
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-08
Last Update Date:2008-05-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IDV8446OtherBLUECROSS
ID000010015543OtherBLUESHIELD
ID002605600Medicaid
ID1373131Medicare PIN
ID0606060001Medicare NSC