Healthcare Provider Details

I. General information

NPI: 1083209951
Provider Name (Legal Business Name): ENVISION SPECIALTY EYECARE AND DRY EYE CENTER PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/03/2021
Last Update Date: 09/03/2026
Certification Date: 09/03/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3752 E AMITY AVE STE 103
NAMPA ID
83687-1221
US

IV. Provider business mailing address

3752 E AMITY AVE STE 103
NAMPA ID
83687-1221
US

V. Phone/Fax

Practice location:
  • Phone: 208-490-8823
  • Fax: 208-490-8525
Mailing address:
  • Phone: 208-490-8823
  • Fax: 208-490-8525

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name: JASON R BESECKER
Title or Position: OPTOMETRIST
Credential: OD, MS
Phone: 208-490-8823