Healthcare Provider Details

I. General information

NPI: 1104762418
Provider Name (Legal Business Name): HIDDEN SPRINGS EYE CARE LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/28/2026
Last Update Date: 04/28/2026
Certification Date: 04/28/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5761 W HIDDEN SPRINGS DR
BOISE ID
83714-9453
US

IV. Provider business mailing address

5761 W HIDDEN SPRINGS DR
BOISE ID
83714-9453
US

V. Phone/Fax

Practice location:
  • Phone: 907-225-2020
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code152W00000X
TaxonomyOptometrist
License Number
License Number State

VIII. Authorized Official

Name: DR. JOSEPH JOHNSON
Title or Position: OWNER
Credential: OD
Phone: 505-785-1926