Provider Demographics
NPI:1902007263
Name:BOISE MOUNTAIN EYE ASSOCIATES, P.C.
Entity Type:Organization
Organization Name:BOISE MOUNTAIN EYE ASSOCIATES, P.C.
Other - Org Name:BOISE MOUNTAIN EYECARE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:TODD
Authorized Official - Middle Name:A
Authorized Official - Last Name:STEBEL
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:208-938-9900
Mailing Address - Street 1:13075 PERSIMMON LN., SUITE A
Mailing Address - Street 2:
Mailing Address - City:BOISE
Mailing Address - State:ID
Mailing Address - Zip Code:83713-2078
Mailing Address - Country:US
Mailing Address - Phone:208-938-9900
Mailing Address - Fax:208-939-9264
Practice Address - Street 1:13075 PERSIMMON LN., SUITE A
Practice Address - Street 2:
Practice Address - City:BOISE
Practice Address - State:ID
Practice Address - Zip Code:83713-2078
Practice Address - Country:US
Practice Address - Phone:208-938-9900
Practice Address - Fax:208-939-9264
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-31
Last Update Date:2008-02-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IDODP-1022152W00000X
IDODP-1027152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
ID1144263963OtherNPI-DR. TODD STEBEL
ID1982654612OtherNPI - DR. HOLLY STEBEL
ID1982654612OtherNPI - DR. HOLLY STEBEL
ID4605460001Medicare NSC