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General NPI Number Information
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NPI Number | 1477353902
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Entity Type | Organization
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Legal Business Name | EYECARE CENTER REXBURG LLC
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Dates
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Enumeration Date | 03/14/2025
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Last Update Date | 12/08/2025
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Provider Practice Location Address
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Address Line | 345 N 2ND E STE 1
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City | REXBURG
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State | ID
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Zip | 83440-1603
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Country | US
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Telephone | 208-359-2020
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Fax | 208-264-9454
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Provider Business Mailing Address
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Address Line | 128 N 4010 E
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City | RIGBY
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State | ID
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Zip | 83442-5787
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Country | US
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Telephone | 208-351-6616
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | DR. MELANIE CLARK
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Credential | OD
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Telephone | 208-351-6616
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 152W00000X
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Taxonomy Name | Optometrist
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License Number |
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License Number State |
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