Healthcare Provider Details

I. General information

NPI: 1871317784
Provider Name (Legal Business Name): 2020 EYECARE LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/08/2024
Last Update Date: 04/27/2026
Certification Date: 04/27/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2708 W PEAK CLOUD LN STE 100
MERIDIAN ID
83642-1160
US

IV. Provider business mailing address

3418 S DONNINGTON PL
EAGLE ID
83616-5248
US

V. Phone/Fax

Practice location:
  • Phone: 208-575-2020
  • Fax: 208-207-8191
Mailing address:
  • Phone: 208-860-4829
  • Fax: 208-207-8191

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name: SHEMAYNE JAHNER MCCARTHY
Title or Position: OPTOMETRIST
Credential:
Phone: 208-860-4829