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General NPI Number Information
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NPI Number | 1306282462
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Entity Type | Organization
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Legal Business Name | SPECTUS RLLP
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Dates
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Enumeration Date | 05/16/2013
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Last Update Date | 06/13/2013
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Provider Practice Location Address
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Address Line | 400 E 1ST ST SUITE 314
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City | CASPER
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State | WY
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Zip | 82601-2561
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Country | US
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Telephone | 307-266-2020
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Fax | 307-234-8074
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Provider Business Mailing Address
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Address Line | 400 E 1ST ST SUITE 314
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City | CASPER
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State | WY
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Zip | 82601-2561
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Country | US
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Telephone | 307-266-2020
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Fax | 307-234-8074
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Authorized Official
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Title or Position | MANAGING PARTNER
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Name | DR. NICK J BRATTIS
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Credential | OD
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Telephone | 307-266-2020
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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 | 120-T
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License Number State | WY
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