Healthcare Provider Details

I. General information

NPI: 1598940421
Provider Name (Legal Business Name): TREE CITY EYECARE PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/09/2008
Last Update Date: 08/04/2023
Certification Date: 08/04/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

700 N RAYMOND ST
BOISE ID
83704-9261
US

IV. Provider business mailing address

700 N RAYMOND ST
BOISE ID
83704-9261
US

V. Phone/Fax

Practice location:
  • Phone: 208-375-3871
  • Fax: 208-321-1765
Mailing address:
  • Phone: 208-375-3871
  • Fax: 208-321-1765

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code152W00000X
TaxonomyOptometrist
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code152WC0802X
TaxonomyCorneal and Contact Management Optometrist
License Number
License Number State

VIII. Authorized Official

Name: DR. JAIMEN DIXON
Title or Position: OWNER
Credential: OD
Phone: 208-375-3871