Individual
MISS CARRIE INEZ WILLIAMS
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
OD
Contact information
Practice address
385 N OVERLAND AVE, STORE 1900, BURLEY, ID 83318
(208) 677-5465
(208) 677-5467
Mailing address
PO BOX 1343, SUN VALLEY, ID 83353-1343
(208) 309-1136
Taxonomy
Speciality
Code
Description
License number
State
152W00000X
Optometrist
Primary
ODP100019
ID
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
000010140999
REGENCE OF BLUE SHIELD
ID
01
—
V5962
BCBS OF IDAHO
ID
Enumeration date
11/14/2006
Last updated
07/08/2007
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