MEDICARE: NORTHERN WYOMING OPHTHALMOLOGY, P.C.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	156FX1800X	Optician

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1124220645
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	NORTHERN WYOMING OPHTHALMOLOGY, P.C.

Provider Business Mailing Address
First Line	:	424 YELLOWSTONE AVE
Second Line	:	SUITE 110
City	:	CODY
State	:	WY
Zip	:	82414-3423
Country	:	US
Telephone Number	:	307-587-5788
Fax Number	:	307-587-4896

Provider Business Practice Location Address
First Line	:	424 YELLOWSTONE AVE
Second Line	:	SUITE 110
City	:	CODY
State	:	WY
Zip	:	82414-3423
Country	:	US
Telephone Number	:	307-587-5788
Fax Number	:	307-587-4896

Authorized Official
Title or Position	:	OWNER
Name	:	DR. BARRY P. WELCH
Credential	:	M.D.
Telephone Number	:	307-587-5788

Provider Enumeration Date	:	06/05/2007
Last Update Date	:	03/21/2012

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