NPI age
19 years
Enumerated 2006-06-01
● Active Type 2 · Organization
State Of Idaho
State Of Idaho is 1 of 2 optometrist organizations in Idaho.
Primary specialty
Optometrist
Practice locations
1
0 secondary on file
Status
Active
No deactivations on record
Authorized official
Roan
Administrator
Last NPPES update
2020-08-22
Source: monthly bulk 2026-05
How this organization compares
Across 2 active optometrist providers in Idaho.
NPI age
19 years
↑ 1 yr above median
Practice locations
1
0 secondary on file
Subspecialties
0
NPI lifetime · 2006 → 2026
2006-06Enumerated in NPPES
2006
2026
Where they practice
Primary practice location
120 S Cole Rd, Suite 120 - Bldg 3
Boise, ID 837090932
Mailing address
120 S Cole Rd, Suite 120 - Bldg 3
Boise, ID 837090932
Authorized official
Angela Roan
Administrator
📞 2083343220
Specialties
-
Optometrist PrimaryOptometrists who specialize in low-vision care having training to assess visual function, prescribe low-vision devices, develop treatment plans, and recommend other vision rehabilitation services.
Other names on file (1)
Doing-business-as, former, and alternate names recorded by NPPES.
-
Idaho Commission for the Blind & Visually Impaired
Practice context
Single-site organization. Only one practice location on file.
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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.