Healthcare Provider Details

I. General information

NPI: 1598678906
Provider Name (Legal Business Name): EVANS DRY EYE CENTER PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/25/2026
Last Update Date: 09/25/2026
Certification Date: 09/25/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2240 SARATOGA DR
IDAHO FALLS ID
83404-5109
US

IV. Provider business mailing address

4367 E GLADE CREEK RD
IDAHO FALLS ID
83401-6542
US

V. Phone/Fax

Practice location:
  • Phone: 208-932-4265
  • Fax:
Mailing address:
  • Phone: 317-431-9777
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name: KARI SUE ELLIS
Title or Position: OFFICE DIRECTOR
Credential: RN
Phone: 317-431-9777