Provider Demographics
NPI:1437569563
Name:ISEMAN, CARLA RAE (OD)
Entity Type:Individual
Prefix:MISS
First Name:CARLA
Middle Name:RAE
Last Name:ISEMAN
Suffix:
Gender:F
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:106 S ABSAROKA ST
Mailing Address - Street 2:
Mailing Address - City:POWELL
Mailing Address - State:WY
Mailing Address - Zip Code:82435-2708
Mailing Address - Country:US
Mailing Address - Phone:714-840-2020
Mailing Address - Fax:
Practice Address - Street 1:106 S ABSAROKA ST
Practice Address - Street 2:
Practice Address - City:POWELL
Practice Address - State:WY
Practice Address - Zip Code:82435-2708
Practice Address - Country:US
Practice Address - Phone:307-754-2020
Practice Address - Fax:307-764-2300
Is Sole Proprietor?:No
Enumeration Date:2014-04-29
Last Update Date:2020-06-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WY416T152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist