Provider Demographics
NPI:1689485070
Name:IDAHO FAMILY VISION PLLC
Entity type:Organization
Organization Name:IDAHO FAMILY VISION PLLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PARTNER/DOCTOR
Authorized Official - Prefix:
Authorized Official - First Name:CAMERON
Authorized Official - Middle Name:KEITH
Authorized Official - Last Name:HOUSLEY
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:208-529-2700
Mailing Address - Street 1:2405 JAFER CT
Mailing Address - Street 2:
Mailing Address - City:IDAHO FALLS
Mailing Address - State:ID
Mailing Address - Zip Code:83404-5587
Mailing Address - Country:US
Mailing Address - Phone:208-529-2700
Mailing Address - Fax:208-529-0873
Practice Address - Street 1:2405 JAFER CT
Practice Address - Street 2:
Practice Address - City:IDAHO FALLS
Practice Address - State:ID
Practice Address - Zip Code:83404-5587
Practice Address - Country:US
Practice Address - Phone:208-529-2700
Practice Address - Fax:208-529-0873
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2025-01-15
Last Update Date:2025-02-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Multi-Specialty