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General NPI Number Information
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NPI Number | 1740669324
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Entity Type | Organization
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Legal Business Name | BACK ENTERPRISES, LLC
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Dates
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Enumeration Date | 05/28/2015
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Last Update Date | 08/04/2015
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Provider Practice Location Address
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Address Line | 327 THELMA DRIVE
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City | CASPER
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State | WY
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Zip | 82609
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Country | US
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Telephone | 307-265-3000
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Fax | 307-265-1890
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Provider Business Mailing Address
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Address Line | 327 THELMA DRIVE
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City | CASPER
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State | WY
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Zip | 82609
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Country | US
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Telephone | 307-265-3000
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Fax | 307-265-1890
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Authorized Official
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Title or Position | PRESIDENT/OWNER
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Name | DR. TERESA TAYLOR-BACK
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Credential | O.D.
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Telephone | 307-265-3000
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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 |
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License Number State |
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