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EYEDAHO OPTOMETRIC LLC
NPI 1417627480
Optometrist in Idaho Falls, ID

Active since September 20, 2021
500 S UTAH AVE, IDAHO FALLS, ID 83402(208) 528-8643 Get Directions Write a Review

NPPES record last updated: September 20, 2021. Verified against the NPPES registry weekly; last sync: October 25, 2026.

About Eyedaho Optometric Llc NPPES

Official registry information on file with the National Plan and Provider Enumeration System.

EYEDAHO OPTOMETRIC LLC (NPI 1417627480) is a healthcare organization registered as an optometrist in Idaho Falls, Idaho and active in the NPI registry since September 2021. The organization lists Trevor Dickson, Owner, as its authorized official.

NPPES Registry Identity

NPI1417627480
Entity TypeOrganization
Primary Taxonomy152W00000X
Legal Business NameEYEDAHO OPTOMETRIC LLC
Location Address500 S UTAH AVEIdaho Falls, ID 83402-3305
Mailing Address500 S Utah AveIdaho Falls, ID 83402-3305 · (208) 528-8643 · Fax (208) 528-7243
Phone(208) 528-8643
Organization SubpartNo
Authorized OfficialTrevor DicksonOwner · (208) 709-5371
Enumeration DateSeptember 20, 2021
NPPES CertifiedSeptember 2, 2021
✔ NPI 1417627480 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses

★ Primary SpecialtyOptometristEye and Vision Services Providers
Taxonomy Code152W00000X
Definition
Doctors of optometry (ODs) are the primary health care professionals for the eye. Optometrists examine, diagnose, treat, and manage diseases, injuries, and disorders of the visual system, the eye, and associated structures as well as identify related systemic conditions affecting the eye. An optometrist has completed pre-professional undergraduate education in a college or university and four years of professional education at a college of optometry, leading to the doctor of optometry (O.D.) degree. Some optometrists complete an optional residency in a specific area of practice. Optometrists are eye health care professionals state-licensed to diagnose and treat diseases and disorders of the eye and visual system.
500 S UTAH AVE, Idaho Falls, ID 83402
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Other Identifiers 1

MedicaidIDTPID015646ID

Group Practice 1

Group TaxonomyThis provdier is a business group of one or more individual practitioners, all of who practice with the same area of specialization.193400000X SINGLE SPECIALTY GROUP

Medicare Participation & PECOS CMS

Medicare enrollment and the clinicians who bill Medicare through this organization, from CMS.

Medicare Enrollment Status

✔

Enrolled in Medicare (PECOS)

Eyedaho Optometric Llc is registered in the CMS Provider Enrollment, Chain and Ownership System (PECOS).

Clinicians Billing Medicare Through This Organization

Medicare enrollment records show 1 clinician reassigns Medicare billing to Eyedaho Optometric LLC, which bills Medicare for the services this clinician delivers.

Clinician (1)

Trevor Dickson, OD
Optometry
NPI 1588280176
500 S UTAH AVE
Idaho Falls, ID 83402
(208) 709-5371
✔ PECOSSame address

Source: CMS Revalidation Reassignment List, October 2026 release. Reassignment records can lag staffing changes; confirm a current affiliation with the organization.

Frequently Asked Questions NPPES & CMS

Common questions about this NPI record, answered from the official NPPES registry and CMS datasets shown on this page.

What is Eyedaho Optometric LLC's NPI number?

The NPI number for Eyedaho Optometric LLC is 1417627480. It was assigned to this organization in the NPPES registry on September 20, 2021.

Where is Eyedaho Optometric LLC located?

Eyedaho Optometric LLC is located at 500 S Utah Ave, Idaho Falls, ID 83402. The listed phone number is (208) 528-8643.

What is Eyedaho Optometric LLC's specialty?

The primary specialty registered for this NPI is Optometrist with taxonomy code 152W00000X.

Is Eyedaho Optometric LLC enrolled in Medicare?

Yes. Eyedaho Optometric LLC is registered in the Medicare PECOS enrollment system.

How many clinicians bill Medicare through Eyedaho Optometric LLC?

According to the CMS Revalidation Reassignment List (October 2026 release), 1 clinician (Optometry) reassigns their Medicare billing to Eyedaho Optometric LLC. A reassignment is filed with Medicare on form CMS-855R, signed by both the clinician and the organization, and lets the organization bill Medicare and receive payment for the clinician's services. Reassignment records can lag staffing changes; confirm a current affiliation with the organization.

When was this NPI record last updated?

The NPPES record for Eyedaho Optometric LLC was last updated on September 20, 2021. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 5 years ago. If this record has changed at CMS more recently, you can request an on-demand re-check against the live CMS registry, directly from this page.