Individual
MR. WILLIAM THOMAS BLACK
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
OD
Contact information
Practice address
420 E ELM ST, CALDWELL, ID 83605-4846
(208) 459-2020
(208) 459-2034
Mailing address
420 E ELM ST, CALDWELL, ID 83605-4846
(208) 459-2020
(208) 459-2034
Taxonomy
Speciality
Code
Description
License number
State
152W00000X
Optometrist
Primary
ID0857
ID
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
002752500
—
ID
Enumeration date
11/02/2006
Last updated
08/30/2012
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