Healthcare Provider Details

I. General information

NPI: 1215928429
Provider Name (Legal Business Name): NORTHERN WYOMING OPHTHALMOLOGY, P.C.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/04/2005
Last Update Date: 10/18/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

424 YELLOWSTONE AVE SUITE 110
CODY WY
82414-9318
US

IV. Provider business mailing address

424 YELLOWSTONE AVE SUITE 110
CODY WY
82414-9318
US

V. Phone/Fax

Practice location:
  • Phone: 307-587-5538
  • Fax: 307-587-4896
Mailing address:
  • Phone: 307-587-5538
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207W00000X
TaxonomyOphthalmology Physician
License Number
License Number State

VIII. Authorized Official

Name: BARRY P WELCH
Title or Position: PRESIDENT
Credential: M.D.
Phone: 307-587-5538