Healthcare Provider Details

I. General information

NPI: 1962494690
Provider Name (Legal Business Name): RIVERTON VISION CENTER P.C.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/18/2005
Last Update Date: 05/13/2024
Certification Date: 05/13/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

300 N BROADWAY AVE
RIVERTON WY
82501-3545
US

IV. Provider business mailing address

300 N BROADWAY AVE
RIVERTON WY
82501-3545
US

V. Phone/Fax

Practice location:
  • Phone: 307-856-9451
  • Fax: 307-856-8548
Mailing address:
  • Phone: 307-856-9451
  • Fax: 307-856-8548

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code152W00000X
TaxonomyOptometrist
License Number
License Number State

VIII. Authorized Official

Name: MR. BRIAN J BALLARD
Title or Position: OWNER
Credential: O.D.
Phone: 307-856-9451