Healthcare Provider Details

I. General information

NPI: 1255267134
Provider Name (Legal Business Name): JACOB BELUS OD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/19/2026
Last Update Date: 06/19/2026
Certification Date: 06/19/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1450 SUGARLAND DR
SHERIDAN WY
82801-5730
US

IV. Provider business mailing address

1450 SUGARLAND DR
SHERIDAN WY
82801-5730
US

V. Phone/Fax

Practice location:
  • Phone: 307-673-5177
  • Fax: 307-673-5170
Mailing address:
  • Phone: 307-673-5177
  • Fax: 307-673-5170

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code152W00000X
TaxonomyOptometrist
License Number477T
License Number StateWY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: