Provider Demographics
NPI:1124220645
Name:NORTHERN WYOMING OPHTHALMOLOGY, P.C.
Entity Type:Organization
Organization Name:NORTHERN WYOMING OPHTHALMOLOGY, P.C.
Other - Org Name:NEW IMAGE EYEWEAR
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:BARRY
Authorized Official - Middle Name:P
Authorized Official - Last Name:WELCH
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:307-587-5788
Mailing Address - Street 1:424 YELLOWSTONE AVE
Mailing Address - Street 2:SUITE 110
Mailing Address - City:CODY
Mailing Address - State:WY
Mailing Address - Zip Code:82414-3423
Mailing Address - Country:US
Mailing Address - Phone:307-587-5788
Mailing Address - Fax:307-587-4896
Practice Address - Street 1:424 YELLOWSTONE AVE
Practice Address - Street 2:SUITE 110
Practice Address - City:CODY
Practice Address - State:WY
Practice Address - Zip Code:82414-3423
Practice Address - Country:US
Practice Address - Phone:307-587-5788
Practice Address - Fax:307-587-4896
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:NORTHERN WYOMING OPHTAHLMOLOGY, PC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2007-06-05
Last Update Date:2012-03-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes156FX1800XEye and Vision Services ProvidersTechnician/TechnologistOpticianGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
WY113960600Medicaid
WYF33909Medicare UPIN
WY113960600Medicaid