=====================================================
General NPI Number Information
=====================================================
NPI Number | 1598678906
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | EVANS DRY EYE CENTER PLLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 09/25/2026
-----------------------------------------------------
Last Update Date | 09/25/2026
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 2240 SARATOGA DR
-----------------------------------------------------
City | IDAHO FALLS
-----------------------------------------------------
State | ID
-----------------------------------------------------
Zip | 83404-5109
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 208-932-4265
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 4367 E GLADE CREEK RD
-----------------------------------------------------
City | IDAHO FALLS
-----------------------------------------------------
State | ID
-----------------------------------------------------
Zip | 83401-6542
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 317-431-9777
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OFFICE DIRECTOR
-----------------------------------------------------
Name | KARI SUE ELLIS
-----------------------------------------------------
Credential | RN
-----------------------------------------------------
Telephone | 317-431-9777
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 152W00000X
-----------------------------------------------------
Taxonomy Name | Optometrist
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------