Healthcare Provider Details

I. General information

NPI: 1477353902
Provider Name (Legal Business Name): EYECARE CENTER REXBURG LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/14/2025
Last Update Date: 12/08/2025
Certification Date: 12/08/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

345 N 2ND E STE 1
REXBURG ID
83440-1603
US

IV. Provider business mailing address

128 N 4010 E
RIGBY ID
83442-5787
US

V. Phone/Fax

Practice location:
  • Phone: 208-359-2020
  • Fax: 208-264-9454
Mailing address:
  • Phone: 208-351-6616
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name: DR. MELANIE CLARK
Title or Position: OWNER
Credential: OD
Phone: 208-351-6616