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General NPI Number Information
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NPI Number | 1215928429
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Entity Type | Organization
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Legal Business Name | NORTHERN WYOMING OPHTHALMOLOGY, P.C.
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Dates
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Enumeration Date | 11/04/2005
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Last Update Date | 10/18/2012
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Provider Practice Location Address
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Address Line | 424 YELLOWSTONE AVE SUITE 110
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City | CODY
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State | WY
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Zip | 82414-9318
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Country | US
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Telephone | 307-587-5538
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Fax | 307-587-4896
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Provider Business Mailing Address
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Address Line | 424 YELLOWSTONE AVE SUITE 110
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City | CODY
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State | WY
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Zip | 82414-9318
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Country | US
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Telephone | 307-587-5538
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Fax |
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Authorized Official
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Title or Position | PRESIDENT
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Name | BARRY P WELCH
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Credential | M.D.
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Telephone | 307-587-5538
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207W00000X
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Taxonomy Name | Ophthalmology Physician
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License Number |
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License Number State |
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