MEDICARE: PORTER EYECARE PLLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	152W00000X	Optometrist	IDP 100113	ID

General Provider Information

NPI Number	:	1770851446
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	PORTER EYECARE PLLC

Provider Business Mailing Address
First Line	:	852 E PARRI DR
Second Line	:
City	:	IDAHO FALLS
State	:	ID
Zip	:	83401-5626
Country	:	US
Telephone Number	:	208-525-8686
Fax Number	:	208-525-8684

Provider Business Practice Location Address
First Line	:	1480 E LINCOLN RD STE B
Second Line	:
City	:	IDAHO FALLS
State	:	ID
Zip	:	83401-2128
Country	:	US
Telephone Number	:	208-525-8686
Fax Number	:	208-525-8684

Authorized Official
Title or Position	:	OWNER
Name	:	LISA LIN PORTER
Credential	:	OD
Telephone Number	:	208-757-0441

Provider Enumeration Date	:	12/08/2011
Last Update Date	:	03/20/2014

Similar Medicare Providers

1447337068 — STEPHANIE GANSCHOW PHARMD
Practice Location Address:

2500 E 52ND ST N , CIGNA MEDICARE SERVICES
SIOUX FALLS, SD
57104-7106

Practice Phone: 605-373-0100
Practice Fax:

1174524722 — DR. KENNETH WILLIAM KING JR. O.D.
Practice Location Address:

1480 E LINCOLN RD
IDAHO FALLS, ID
83401-2128

Practice Phone: 208-525-8686
Practice Fax: 208-525-8684

1215962915 — DR. LISA L. PORTER O.D.
Practice Location Address:

1480 E LINCOLN RD STE B
IDAHO FALLS, ID
83401-2128

Practice Phone: 208-525-8686
Practice Fax: 208-525-8684

1194174441 — MR. SCOTT DAVID HYATT O.D.
Practice Location Address:

1480 E LINCOLN RD
IDAHO FALLS, ID
83401-2128

Practice Phone: 208-525-8686
Practice Fax:

1841921863 — BRIAN J MCKEON OD
Practice Location Address:

1480 E LINCOLN RD
IDAHO FALLS, ID
83401-2128

Practice Phone: 208-525-8686
Practice Fax: 208-525-8684

1366676884 — VALERIE SIMONSON
Practice Location Address:

2128 SAINT CLAIR RD # 8
IDAHO FALLS, ID
83404-6355

Practice Phone: 208-339-0378
Practice Fax:

Directions to “PORTER EYECARE PLLC ” Practice Location

Language	Start Address	Practice Location

These directions are for planning purposes only. You may find that construction projects, traffic, or other events may cause road conditions to differ from the map results.

Copyright © 2007-2025 (Powered by Swiss Vault Engine), all rights reserved. HIPAA liability, trademark, document use and software licensing rules apply. All registered trademarks, used in the content, are the property of their owners. Your interactions with this site are in accordance with our Terms of Use and Privacy Policy.