Individual
DR. ALEXANDER C ARCHIBALD
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
OD
Contact information
Practice address
2822 S VISTA AVE, BOISE, ID 83705-4159
(208) 385-7576
(208) 385-0050
Mailing address
PO BOX 1506, CHEHALIS, WA 98532-0409
(360) 242-3008
(360) 807-7687
Taxonomy
Speciality
Code
Description
License number
State
152W00000X
Optometrist
783
MT
152W00000X
Optometrist
OD00004125
WA
152W00000X
Optometrist
ODP-100138
ID
152W00000X
Optometrist
Primary
OPT-OPT-LIC-783
MT
152W00000X
Optometrist
OPT597
NM
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
P00381019
RAIL ROAD MEDICARE
WA
Enumeration date
12/29/2006
Last updated
11/13/2020
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