Healthcare Provider Details

I. General information

NPI: 1013826353
Provider Name (Legal Business Name): NORTH LIGHT EYECARE PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/03/2026
Last Update Date: 09/03/2026
Certification Date: 09/02/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1951 BENCH RD
POCATELLO ID
83201-2013
US

IV. Provider business mailing address

235 CENTENNIAL ST
BLACKFOOT ID
83221-3963
US

V. Phone/Fax

Practice location:
  • Phone: 208-681-5972
  • Fax:
Mailing address:
  • Phone: 208-681-5972
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name: NICHOLAS BLIGHT
Title or Position: OWNER
Credential: OD
Phone: 208-681-5972