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General NPI Number Information
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NPI Number | 1134303068
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Entity Type | Organization
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Legal Business Name | BEYOND 20/20
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Dates
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Enumeration Date | 12/27/2007
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Last Update Date | 12/27/2007
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Provider Practice Location Address
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Address Line | 1401 AIRPORT PKWY SUITE 120
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City | CHEYENNE
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State | WY
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Zip | 82001-1518
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Country | US
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Telephone | 307-775-0800
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Fax | 307-775-0808
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Provider Business Mailing Address
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Address Line | 1401 AIRPORT PKWY SUITE 120
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City | CHEYENNE
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State | WY
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Zip | 82001-1518
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Country | US
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Telephone | 307-775-0800
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Fax | 307-775-0808
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. JACEE R COTTON
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Credential | O.D.
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Telephone | 307-775-0800
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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 | 266T
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License Number State | WY
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