| Shelley Eyecare | |
|
524 N State St, Shelley, ID 83274-1154 | |
| (208) 357-5733 | |
| (208) 357-2240 |
| Full Name | Shelley Eyecare |
|---|---|
| Type | Facility |
| Speciality | Optometrist |
| Location | 524 N State St, Shelley, Idaho |
| Accepts Medicare Assignments | Medicare enrolled and accepts medicare insurance. Providers at this facility may prescribe medicare part D drugs. |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1780784769 | NPI | - | NPPES |
| 806877400 | Medicaid | ID |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 152W00000X | Optometrist | ODP 638 (Idaho) | Primary |
| 152W00000X | Optometrist | ODP 100034 (Idaho) | Secondary |
| Provider Name | Nathan G Kohler |
|---|---|
| Provider Type | Practitioner - Optometry |
| Provider Identifiers | NPI Number: 1386842425 PECOS PAC ID: 8527029289 Enrollment ID: I20041029000137 |
| Provider Name | Kristan C Sparks |
|---|---|
| Provider Type | Practitioner - Optometry |
| Provider Identifiers | NPI Number: 1174723332 PECOS PAC ID: 7618938374 Enrollment ID: I20041029000149 |
| Provider Name | Justin T Heintz |
|---|---|
| Provider Type | Practitioner - Optometry |
| Provider Identifiers | NPI Number: 1548499882 PECOS PAC ID: 7113056094 Enrollment ID: I20240403003993 |
| Mailing Address | Practice Location Address |
|---|---|
| Shelley Eyecare 524 N State St, Shelley, ID 83274-1154 Ph: (208) 357-5733 | Shelley Eyecare 524 N State St, Shelley, ID 83274-1154 Ph: (208) 357-5733 |
Dr. Kristan C Sparks, O.D. Optometrist Medicare: Accepting Medicare Assignments Practice Location: 169 S Emerson Ave, Shelley, ID 83274 Phone: 208-357-5733 Fax: 208-357-2240 | |
Snake River Eye Associates Of Shelley, Pllc Optometrist Medicare: Medicare Enrolled Practice Location: 357 W Fir St, Shelley, ID 83274 Phone: 208-881-5145 Fax: 208-881-5146 | |
Dr. Justin Thomas Heintz, OD Optometrist Medicare: Accepting Medicare Assignments Practice Location: 524 N State St, Shelley, ID 83274 Phone: 208-357-5733 Fax: 208-357-2240 |