Healthcare Provider Details

I. General information

NPI: 1952458499
Provider Name (Legal Business Name): BEVERLY NOTT, OD PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/05/2007
Last Update Date: 01/16/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1210 S RIVER ST
SARATOGA WY
82331-0025
US

IV. Provider business mailing address

PO BOX 25
SARATOGA WY
82331-0025
US

V. Phone/Fax

Practice location:
  • Phone: 307-326-8714
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code152W00000X
TaxonomyOptometrist
License Number283T
License Number StateWY

VIII. Authorized Official

Name: BEVERLY NOTT
Title or Position: OPTOMETRIST
Credential: OD
Phone: 307-326-8714