Healthcare Provider Details

I. General information

NPI: 1154571826
Provider Name (Legal Business Name): WORTHAM VISION CARE,INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/30/2008
Last Update Date: 06/09/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

106 S MAIN
LYMAN WY
82937
US

IV. Provider business mailing address

PO BOX 429
LYMAN WY
82937-0429
US

V. Phone/Fax

Practice location:
  • Phone: 307-787-6123
  • Fax: 307-787-3351
Mailing address:
  • Phone: 307-787-6123
  • Fax: 307-787-3351

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code231H00000X
TaxonomyAudiologist
License NumberA933
License Number StateWY
# 2
Primary TaxonomyY
Taxonomy Code152W00000X
TaxonomyOptometrist
License NumberT197
License Number StateWY

VIII. Authorized Official

Name: MRS. BILLIE S WORTHAM
Title or Position: AUDIOLOGIST/OWNER
Credential: M.S.,CCCA
Phone: 307-787-6123