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General NPI Number Information
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NPI Number | 1023067915
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Entity Type | Individual
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Provider Name | WAYNE HUDSON
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Gender | Male
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Dates
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Enumeration Date | 05/08/2006
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Last Update Date | 08/27/2010
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Provider Practice Location Address
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Address Line | 124 N 4TH ST
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City | DOUGLAS
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State | WY
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Zip | 82633-2402
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Country | US
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Telephone | 307-358-9008
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Fax | 307-358-5183
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Provider Business Mailing Address
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Address Line | 124 N 4TH ST
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City | DOUGLAS
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State | WY
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Zip | 82633-2402
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 152W00000X
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Taxonomy Name | Optometrist
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License Number | 128T
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License Number State | WY
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