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NPI Code Detail

MEDICARE: OPTIQUE 20/20, INC-GREEN RIVER

MEDICARE: OPTIQUE 20/20, INC-GREEN RIVER
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
1332H00000XEyewear Supplier

General Provider Information

NPI Number : 1225075039
Entity Type Code : Organization
Provider Name (Legal Business Name) : OPTIQUE 20/20, INC-GREEN RIVER
Provider Business Mailing Address
First Line : 175 RIVERVIEW DR
Second Line : SUITE E & F
City : GREEN RIVER
State : WY
Zip : 82935-4811
Country : US
Telephone Number : 307-875-4040
Fax Number :
Provider Business Practice Location Address
First Line : 175 RIVERVIEW DR
Second Line : SUITE E & F
City : GREEN RIVER
State : WY
Zip : 82935-4811
Country : US
Telephone Number : 307-875-4040
Fax Number :
Authorized Official
Title or Position : PRESIDENT OF CORP
Name : DR. JAMESQ R BYARS JR.
Credential : OD
Telephone Number : 307-875-4040
Provider Enumeration Date : 06/01/2006
Last Update Date : 08/22/2020

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Directions to “OPTIQUE 20/20, INC-GREEN RIVER ” Practice Location

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