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General NPI Number Information
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NPI Number | 1962494690
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Entity Type | Organization
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Legal Business Name | RIVERTON VISION CENTER P.C.
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Dates
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Enumeration Date | 08/18/2005
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Last Update Date | 05/13/2024
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Provider Practice Location Address
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Address Line | 300 N BROADWAY AVE
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City | RIVERTON
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State | WY
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Zip | 82501-3545
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Country | US
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Telephone | 307-856-9451
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Fax | 307-856-8548
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Provider Business Mailing Address
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Address Line | 300 N BROADWAY AVE
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City | RIVERTON
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State | WY
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Zip | 82501-3545
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Country | US
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Telephone | 307-856-9451
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Fax | 307-856-8548
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Authorized Official
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Title or Position | OWNER
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Name | MR. BRIAN J BALLARD
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Credential | O.D.
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Telephone | 307-856-9451
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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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