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General NPI Number Information
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NPI Number | 1881740769
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Entity Type | Individual
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Provider Name | SUSAN L. FARMER O.D.
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Gender | Female
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Dates
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Enumeration Date | 01/25/2007
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Last Update Date | 08/23/2024
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Provider Practice Location Address
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Address Line | 1906 FAIRVIEW AVE STE 100
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City | CALDWELL
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State | ID
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Zip | 83605-5433
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Country | US
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Telephone | 208-459-2020
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Fax | 208-459-2034
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Provider Business Mailing Address
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Address Line | 1906 FAIRVIEW AVE STE 100
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City | CALDWELL
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State | ID
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Zip | 83605-5433
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Country | US
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Telephone | 208-459-2020
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Fax | 208-459-2034
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 152W00000X
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Taxonomy Name | Optometrist
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License Number | OD00003018
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License Number State | WA
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Taxonomy #2
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Taxonomy Code | 152W00000X
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Taxonomy Name | Optometrist
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License Number | 868
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License Number State | ID
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