Individual
KYLE J WILLIAMS
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
OD
Contact information
Practice address
180 1ST AVE N, KETCHUM, ID 83340-6129
(208) 726-3363
(208) 726-0138
Mailing address
PO BOX 6129, KETCHUM, ID 83340-6129
(208) 726-3363
(508) 726-0138
Taxonomy
Speciality
Code
Description
License number
State
152W00000X
Optometrist
Primary
ODP100080
ID
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
807261300
—
ID
Enumeration date
08/31/2006
Last updated
07/27/2010
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