Provider Demographics
NPI:1336359694
Name:CLEARVIEW FAMILY EYECARE PLLC
Entity Type:Organization
Organization Name:CLEARVIEW FAMILY EYECARE PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:CHARLES
Authorized Official - Middle Name:R
Authorized Official - Last Name:NICHOLSON
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:208-322-8439
Mailing Address - Street 1:11513 W FAIRVIEW AVE
Mailing Address - Street 2:SUITE 106
Mailing Address - City:BOISE
Mailing Address - State:ID
Mailing Address - Zip Code:83713-7886
Mailing Address - Country:US
Mailing Address - Phone:208-322-8439
Mailing Address - Fax:208-322-8430
Practice Address - Street 1:11513 W FAIRVIEW AVE
Practice Address - Street 2:SUITE 106
Practice Address - City:BOISE
Practice Address - State:ID
Practice Address - Zip Code:83713-7886
Practice Address - Country:US
Practice Address - Phone:208-322-8439
Practice Address - Fax:208-322-8430
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-23
Last Update Date:2009-01-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IDODP-100134152W00000X
IDODP-100135152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
ID000010162495OtherREGENCE BLUE SHIELD
ID000010162495OtherREGENCE BLUE SHIELD