Healthcare Provider Details

I. General information

NPI: 1700922044
Provider Name (Legal Business Name): BURLEY EYE CARE CENTER, L.L.P.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/30/2007
Last Update Date: 03/19/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1970 OVERLAND AVE
BURLEY ID
83318-2439
US

IV. Provider business mailing address

1970 OVERLAND AVE
BURLEY ID
83318-2439
US

V. Phone/Fax

Practice location:
  • Phone: 208-678-3539
  • Fax: 208-678-2949
Mailing address:
  • Phone: 208-678-3539
  • Fax: 208-678-2949

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code152W00000X
TaxonomyOptometrist
License NumberODP-501
License Number StateID
# 2
Primary TaxonomyY
Taxonomy Code152W00000X
TaxonomyOptometrist
License NumberODP-969
License Number StateID

VIII. Authorized Official

Name: DR. DELBERT OMAN
Title or Position: CO-OWNER
Credential: O.D.
Phone: 208-678-3539