Provider Demographics
NPI:1578635967
Name:WILLIAMS, CARRIE INEZ (OD)
Entity Type:Individual
Prefix:MISS
First Name:CARRIE
Middle Name:INEZ
Last Name:WILLIAMS
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:PO BOX 1343
Mailing Address - Street 2:
Mailing Address - City:SUN VALLEY
Mailing Address - State:ID
Mailing Address - Zip Code:83353-1343
Mailing Address - Country:US
Mailing Address - Phone:208-309-1136
Mailing Address - Fax:
Practice Address - Street 1:385 N OVERLAND AVE
Practice Address - Street 2:STORE 1900
Practice Address - City:BURLEY
Practice Address - State:ID
Practice Address - Zip Code:83318
Practice Address - Country:US
Practice Address - Phone:208-677-5465
Practice Address - Fax:208-677-5467
Is Sole Proprietor?:No
Enumeration Date:2006-11-14
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IDODP100019152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
ID000010140999OtherREGENCE OF BLUE SHIELD
IDV5962OtherBCBS OF IDAHO
IDV5962OtherBCBS OF IDAHO