NPI age
19 years
Enumerated 2006-11-28
● Active Type 2 · Organization
Subpart
Idaho Eye Center PA
Idaho Eye Center PA is 1 of 99 clinic/center organizations in Idaho.
Primary specialty
Clinic/Center
Practice locations
1
0 secondary on file
Status
Active
No deactivations on record
Authorized official
Gardner
Senior Vice President
Last NPPES update
2008-08-12
Source: monthly bulk 2026-05
How this organization compares
Across 99 active clinic/center providers in Idaho.
NPI age
19 years
≈ at median (18 yr)
Practice locations
1
0 secondary on file
Subspecialties
0
NPI lifetime · 2006 → 2026
2006-11Enumerated in NPPES
2006
2026
Where they practice
Primary practice location
2025 E 17th St
Idaho Falls, ID 83404
Mailing address
2025 E 17th St
Idaho Falls, ID 83404
Authorized official
Bradley P Gardner, MD
Senior Vice President
📞 2085242025
Individual providers at this organization
7 individual providers on file at this primary practice address.
- Richard Cannon, MD Ophthalmology NPI 1992842264
- James Davis, OD Optometrist NPI 1326115395
- Bradley Gardner, MD Ophthalmology NPI 1255408217
- Spencer Harris, MD Ophthalmology NPI 1255892568
- Eric Romriell, DO Ophthalmology NPI 1922072586
- Kenneth Turley, MD Ophthalmology NPI 1063589034
- Shane Wynn, OD Optometrist NPI 1427125491
Specialties
-
Clinic/Center PrimaryDefinition to come...
Identifiers
| Type | Value | Notes |
|---|---|---|
| 01 (ID) | 490000614 | RAILROAD MEDICARE |
| 01 (ID) | 480000614 | RAILROAD MEDICARE |
| 01 (ID) | 00984 | BLUE CROSS |
| 05 (ID) | 002562201 | |
| 05 (ID) | 002565200 | |
| 01 (ID) | 105947500 | WYOMING MEDICAID |
| 01 (ID) | 5207 | BLUE CROSS |
Other names on file (1)
Doing-business-as, former, and alternate names recorded by NPPES.
-
Idaho Eye Surgicenter
Practice context
Multi-provider organization. 7 individual providers on file at this primary address.
Subpart of Idaho Eye Center PA.
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- Confirm the NPI on NPPES.The CMS registry is the system of record. Open NPPES →
- Verify the organization is in good standing.Cross-check with the state's business registration and any applicable licensing boards.
- Confirm payer enrollment if billing.NPI presence does not guarantee active enrollment with Medicare, Medicaid, or commercial payers.