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General NPI Number Information
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NPI Number | 1639979917
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Entity Type | Organization
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Legal Business Name | EYEBALL LLC
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Dates
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Enumeration Date | 03/17/2025
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Last Update Date | 05/08/2025
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Provider Practice Location Address
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Address Line | 814 PANCHERI DR
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City | IDAHO FALLS
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State | ID
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Zip | 83402-3344
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Country | US
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Telephone | 208-715-8880
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Fax | 208-715-8885
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Provider Business Mailing Address
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Address Line | 814 PANCHERI DR
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City | IDAHO FALLS
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State | ID
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Zip | 83402-3344
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Country | US
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Telephone | 208-715-8880
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Fax | 208-715-8885
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Authorized Official
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Title or Position | OWNER
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Name | DR. JEREMY BALL
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Credential | OD
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Telephone | 951-235-4345
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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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