Provider Demographics
NPI:1841298213
Name:FRENCH, WILLIAM R (OD)
Entity type:Individual
Prefix:DR
First Name:WILLIAM
Middle Name:R
Last Name:FRENCH
Suffix:
Gender:M
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:202 E 7TH ST
Mailing Address - Street 2:
Mailing Address - City:MOSCOW
Mailing Address - State:ID
Mailing Address - Zip Code:83843-3002
Mailing Address - Country:US
Mailing Address - Phone:208-883-3937
Mailing Address - Fax:208-883-3211
Practice Address - Street 1:202 E 7TH ST
Practice Address - Street 2:
Practice Address - City:MOSCOW
Practice Address - State:ID
Practice Address - Zip Code:83843-3002
Practice Address - Country:US
Practice Address - Phone:208-883-3937
Practice Address - Fax:208-883-3211
Is Sole Proprietor?:No
Enumeration Date:2005-07-11
Last Update Date:2011-10-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IDODP-811152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
ID000530300Medicaid
ID000530300Medicaid
264304549OtherTIN
ID264304549OtherMEDICARE TIN
ID264304549OtherMEDICARE TIN
ID0514340001Medicare NSC
ID1591912Medicare ID - Type Unspecified