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General NPI Number Information
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NPI Number | 1891311775
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Entity Type | Individual
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Provider Name | ELIZABETH CARMAN SOMERS OD
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Gender | Female
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Dates
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Enumeration Date | 06/17/2020
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Last Update Date | 11/08/2024
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Provider Practice Location Address
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Address Line | 3621 MARKET LN
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City | KENOSHA
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State | WI
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Zip | 53144-1553
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Country | US
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Telephone | 262-658-8119
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Fax |
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Provider Business Mailing Address
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Address Line | N7330 CRYSTAL RIDGE DR
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City | BEAVER DAM
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State | WI
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Zip | 53916-8917
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Country | US
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Telephone | 920-763-3861
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Fax |
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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 | OPT-002580
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License Number State | AZ
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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 | 3623-35
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License Number State | WI
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