Healthcare Provider Details

I. General information

NPI: 1104931724
Provider Name (Legal Business Name): JOAN MARIE SEARS O.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/21/2006
Last Update Date: 02/23/2024
Certification Date: 02/23/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

444 W FORT ST FL 2
BOISE ID
83702-4535
US

IV. Provider business mailing address

1829 HAMPSHIRE DR
SALISBURY NC
28146
US

V. Phone/Fax

Practice location:
  • Phone: 208-422-1018
  • Fax:
Mailing address:
  • Phone: 706-973-9640
  • Fax: 706-219-1010

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code152W00000X
TaxonomyOptometrist
License Number2258DT
License Number StateKY
# 2
Primary TaxonomyN
Taxonomy Code152WC0802X
TaxonomyCorneal and Contact Management Optometrist
License NumberOPT002237
License Number StateGA
# 3
Primary TaxonomyY
Taxonomy Code152W00000X
TaxonomyOptometrist
License NumberOPT002237
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: