Provider Demographics
NPI:1881740769
Name:FARMER, SUSAN L (OD)
Entity type:Individual
Prefix:DR
First Name:SUSAN
Middle Name:L
Last Name:FARMER
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 1:1906 FAIRVIEW AVE STE 100
Mailing Address - Street 2:
Mailing Address - City:CALDWELL
Mailing Address - State:ID
Mailing Address - Zip Code:83605-5433
Mailing Address - Country:US
Mailing Address - Phone:208-459-2020
Mailing Address - Fax:208-459-2034
Practice Address - Street 1:1906 FAIRVIEW AVE STE 100
Practice Address - Street 2:
Practice Address - City:CALDWELL
Practice Address - State:ID
Practice Address - Zip Code:83605-5433
Practice Address - Country:US
Practice Address - Phone:208-459-2020
Practice Address - Fax:208-459-2034
Is Sole Proprietor?:No
Enumeration Date:2007-01-25
Last Update Date:2024-08-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAOD00003018152W00000X
ID868152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA2016517Medicaid
WAGAB32594Medicare PIN
WA410048489Medicare PIN
WA2016517Medicaid
WAG8872318Medicare PIN