Provider Demographics
NPI:1124082169
Name:CARD, CHRISTOPHER MARK (OD)
Entity type:Individual
Prefix:DR
First Name:CHRISTOPHER
Middle Name:MARK
Last Name:CARD
Suffix:
Gender:M
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1702 S KIMBALL AVE
Mailing Address - Street 2:
Mailing Address - City:CALDWELL
Mailing Address - State:ID
Mailing Address - Zip Code:83605-4826
Mailing Address - Country:US
Mailing Address - Phone:208-459-2641
Mailing Address - Fax:208-459-2895
Practice Address - Street 1:1702 S KIMBALL AVE
Practice Address - Street 2:
Practice Address - City:CALDWELL
Practice Address - State:ID
Practice Address - Zip Code:83605-4826
Practice Address - Country:US
Practice Address - Phone:208-459-2641
Practice Address - Fax:208-459-2895
Is Sole Proprietor?:No
Enumeration Date:2006-04-14
Last Update Date:2010-01-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IDOPD-579152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
ID2309310-01OtherBLUE CROSS OF OREGON
ID000010015187OtherREGENCE BLUE SHIELD OF ID
IDV5608OtherBLUE CROSS OF IDAHO
ID0396900001OtherDMERC
ID002523400Medicaid
IDV5608OtherBLUE CROSS OF IDAHO
ID1591140Medicare ID - Type Unspecified