DR. SHANE L WYNN (NPI# 1427125491) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1427125491 |
| Entity Type | Individual |
| Full Name | DR. SHANE L WYNN |
| Credential | OD |
| Practice Address |
2025 E 17th St Idaho Falls ID 83404 |
| Practice Telephone | 2085242025 |
| Practice Fax Number | 2085291924 |
| Mailing Telephone | 2085242025 |
| Mailing Fax Number | 2085291924 |
| Enumeration Date | 2006-11-28 |
| Last Update Date | 2007-07-08 |
| Gender Code | M |
| Is Sole Proprietor | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 152W00000X | Optometrist | 00P10064 | ID | Eye and Vision Services Providers |
| Street Address |
2025 E 17TH ST |
| City | IDAHO FALLS |
| State | ID |
| Zip Code | 83404 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1922072586 | Eric K Romriell | Ophthalmology | 2025 E 17th St, Idaho Falls, ID 83404 | 2006-02-13 |
| 1992842264 | Richard Cannon | Ophthalmology | 2025 E 17th St, Idaho Falls, ID 83404-6430 | 2007-01-30 |
| 1518021849 | Idaho Eye Center Pa | Ophthalmology | 2025 E 17th St, Idaho Falls, ID 83404 | 2006-12-21 |
| 1629145685 | Idaho Eye Center Pa | Clinic/Center | 2025 E 17th St, Idaho Falls, ID 83404 | 2006-11-28 |
| 1326115395 | James R Davis | Optometrist | 2025 E 17th St, Idaho Falls, ID 83404 | 2006-11-28 |
| 1255408217 | Bradley P Gardner | Ophthalmology | 2025 E 17th St, Idaho Falls, ID 83404 | 2006-11-28 |
| 1063589034 | Kenneth W Turley | Ophthalmology | 2025 E 17th St, Idaho Falls, ID 83404 | 2006-11-28 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1437750809 | Joshua M Murphy | Dentist | 1580 Elk Creek Dr., Idaho Falls, ID 83404 | 2020-11-03 |
| 1427618958 | Eastern Idaho Endodontics | Dentist | 3335 S. Holmes Ave, Idaho Falls, ID 83404 | 2019-06-17 |
| 1942863600 | Muhammad Arslan Khan | Student in an Organized Health Care Education/Training Program | 2860 Channing Way Suite 214, Idaho Falls, ID 83404 | 2019-04-18 |
| 1942771043 | Physician's Choice Cardiology, Pllc | Internal Medicine | 3302 Valencia, Suite 201, Idaho Falls, ID 83404 | 2018-12-16 |
| 1609358761 | Cardiac Cath Lab of Idaho Falls | Internal Medicine | 3311 Valencia Drive, Idaho Falls, ID 83404 | 2018-09-05 |
| 1083196380 | Hannah Golden | Occupational Therapist | 1460 Elk Creek, Idaho Falls, ID 83404 | 2018-09-04 |
| 1316423049 | Lindsay Sessions | Speech-Language Pathologist | 2210 Niagara St, Idaho Falls, ID 83404 | 2018-07-16 |
| 1720574023 | Bmh, Inc. | Anesthesiology | 3302 Valencia Dr., Suite 201, Idaho Falls, ID 83404 | 2018-07-10 |
| 1093237935 | Jason Earl Bailey | Contractor | 3100 S Woodruff Ave., Idaho Falls, ID 83404 | 2017-07-12 |
| 1235682121 | Mountain Falls Quick Care | Clinic/Center | 1995 E 17th St #1, Idaho Falls, ID 83404 | 2016-07-27 |
| Find all providers in zip 83404 | ||||
| Taxonomy Code | 152W00000X |
| Grouping | Eye and Vision Services Providers |
| Classification | Optometrist |
| Doctors of optometry (ODs) are the primary health care professionals for the eye. Optometrists examine, diagnose, treat, and manage diseases, injuries, and disorders of the visual system, the eye, and associated structures as well as identify related systemic conditions affecting the eye. An optometrist has completed pre-professional undergraduate education in a college or university and four years of professional education at a college of optometry, leading to the doctor of optometry (O.D.) degree. Some optometrists complete an optional residency in a specific area of practice. Optometrists are eye health care professionals state-licensed to diagnose and treat diseases and disorders of the eye and visual system. |
| Notes: Source: American Optometric Association (AOA), approved by the AOA’s Board of Trustees, June 21, 2005. [7/1/2006: definition modified] |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1255898292 | Kreed Bowman Od Pllc | Optometrist | 250 S Skyline Dr Ste 6, Idaho Falls, ID 83402-3292 | 2019-02-26 |
| 1972089514 | John Wesley Porter | Optometrist | 3363 Merlin Dr, Idaho Falls, ID 83404-7405 | 2018-07-17 |
| 1720276371 | Keen Eye Family Vision Pa | Optometrist | 2540 Channing Way, Idaho Falls, ID 83404-7515 | 2007-10-09 |
| 1386842425 | Nathan G Kohler | Optometrist | 320 S Woodruff Ave, Idaho Falls, ID 83401-4329 | 2007-07-10 |
| 1477612273 | Owen M Shirts | Optometrist | 838 S Woodruff Ave, Idaho Falls, ID 83401-5296 | 2006-12-07 |
| 1912074741 | David Bryan Cook | Optometrist | 1340 S. Ammon Road, Idaho Falls, ID 83406 | 2006-11-29 |
| 1952477242 | Todd F Birch | Optometrist | 3351 Merlin Dr, Idaho Falls, ID 83404-7405 | 2006-11-28 |
| 1154493708 | Associated Westside Optometric Clinic P.a. | Optometrist | 1991 W Broadway St Ste 2, Idaho Falls, ID 83402-3041 | 2006-11-15 |
| 1881764678 | Jared Edgar Birch | Optometrist | 1689 Pancheri Dr, Idaho Falls, ID 83402-3041 | 2006-11-08 |
| 1245340314 | Jerry Blair Nave | Optometrist | 2550 S 25th E, Idaho Falls, ID 83404 | 2006-08-30 |
| Find all providers in IDAHO FALLS | ||||
| City | IDAHO FALLS |
| Zip Code | 83404 |
Please comment or provide details below to improve the information on DR. SHANE L WYNN.
| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.