Healthcare Provider Details

I. General information

NPI: 1255170205
Provider Name (Legal Business Name): REFRAMED EYE LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/20/2024
Last Update Date: 05/20/2024
Certification Date: 05/20/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3508 S 25TH E
IDAHO FALLS ID
83404-5027
US

IV. Provider business mailing address

3508 S 25TH E
IDAHO FALLS ID
83404-5027
US

V. Phone/Fax

Practice location:
  • Phone: 208-557-3222
  • Fax: 208-561-8692
Mailing address:
  • Phone: 208-557-3222
  • Fax: 208-561-8692

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code152W00000X
TaxonomyOptometrist
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code152WL0500X
TaxonomyLow Vision Rehabilitation Optometrist
License Number
License Number State

VIII. Authorized Official

Name: JAREN OLSEN
Title or Position: OWNER
Credential: OD
Phone: 208-557-3222