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NPI Code Detail

MEDICARE: DR. BRIAN J BALLARD O.D.

MEDICARE:  DR. BRIAN J BALLARD  O.D.
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1152W00000XOptometrist118TWY

Medicare Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
20762340001OTHERWYCIGNA MEDICARE

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1114919826
Entity Type Code : Individual
Provider Name (Legal Business Name) : DR. BRIAN J BALLARD O.D.
Provider Business Mailing Address
First Line : 300 N BROADWAY AVE
Second Line :
City : RIVERTON
State : WY
Zip : 82501-3545
Country : US
Telephone Number : 307-856-9451
Fax Number : 307-856-8548
Provider Business Practice Location Address
First Line : 300 N BROADWAY AVE
Second Line :
City : RIVERTON
State : WY
Zip : 82501-3545
Country : US
Telephone Number : 307-856-9451
Fax Number : 307-856-8548
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 08/18/2005
Last Update Date : 10/07/2011

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Directions to “ DR. BRIAN J BALLARD O.D.” Practice Location

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