MEDICARE: PRIMARY EYECARE INC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	152W00000X	Optometrist	ODP-782	ID

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1083819080
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	PRIMARY EYECARE INC

Provider Business Mailing Address
First Line	:	10454 W OVERLAND RD
Second Line	:
City	:	BOISE
State	:	ID
Zip	:	83709-1433
Country	:	US
Telephone Number	:	208-672-1370
Fax Number	:	208-672-1404

Provider Business Practice Location Address
First Line	:	10454 W OVERLAND RD
Second Line	:
City	:	BOISE
State	:	ID
Zip	:	83709-1433
Country	:	US
Telephone Number	:	208-672-1370
Fax Number	:	208-672-1404

Authorized Official
Title or Position	:	OWNER
Name	:	RICHARD C MURRAY
Credential	:
Telephone Number	:	208-672-1370

Provider Enumeration Date	:	06/19/2007
Last Update Date	:	08/03/2009

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Directions to “PRIMARY EYECARE INC ” Practice Location

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