=====================================================
General NPI Number Information
=====================================================
NPI Number | 1841298213
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | WILLIAM R FRENCH O.D.
-----------------------------------------------------
Gender | Male
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 07/11/2005
-----------------------------------------------------
Last Update Date | 10/08/2011
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 202 E 7TH ST
-----------------------------------------------------
City | MOSCOW
-----------------------------------------------------
State | ID
-----------------------------------------------------
Zip | 83843-3002
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 208-883-3937
-----------------------------------------------------
Fax | 208-883-3211
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 202 E 7TH ST
-----------------------------------------------------
City | MOSCOW
-----------------------------------------------------
State | ID
-----------------------------------------------------
Zip | 83843-3002
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 208-883-3937
-----------------------------------------------------
Fax | 208-883-3211
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 152W00000X
-----------------------------------------------------
Taxonomy Name | Optometrist
-----------------------------------------------------
License Number | ODP-811
-----------------------------------------------------
License Number State | ID
-----------------------------------------------------