Provider Demographics
NPI:1891311775
Name:SOMERS, ELIZABETH CARMAN (OD)
Entity Type:Individual
Prefix:DR
First Name:ELIZABETH
Middle Name:CARMAN
Last Name:SOMERS
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:N7330 CRYSTAL RIDGE DR
Mailing Address - Street 2:
Mailing Address - City:BEAVER DAM
Mailing Address - State:WI
Mailing Address - Zip Code:53916-8917
Mailing Address - Country:US
Mailing Address - Phone:920-763-3861
Mailing Address - Fax:
Practice Address - Street 1:3621 MARKET LN
Practice Address - Street 2:
Practice Address - City:KENOSHA
Practice Address - State:WI
Practice Address - Zip Code:53144-1553
Practice Address - Country:US
Practice Address - Phone:262-658-8119
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-06-17
Last Update Date:2020-06-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI3623-35152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist