Provider Demographics
NPI:1376781872
Name:SHOLEY, THORMAN E (OD)
Entity Type:Individual
Prefix:DR
First Name:THORMAN
Middle Name:E
Last Name:SHOLEY
Suffix:
Gender:M
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:610 S 12TH ST
Mailing Address - Street 2:
Mailing Address - City:WORLAND
Mailing Address - State:WY
Mailing Address - Zip Code:82401-4007
Mailing Address - Country:US
Mailing Address - Phone:307-347-4151
Mailing Address - Fax:307-347-3214
Practice Address - Street 1:610 S 12TH ST
Practice Address - Street 2:
Practice Address - City:WORLAND
Practice Address - State:WY
Practice Address - Zip Code:82401-4007
Practice Address - Country:US
Practice Address - Phone:307-347-4151
Practice Address - Fax:307-347-3214
Is Sole Proprietor?:Yes
Enumeration Date:2009-01-22
Last Update Date:2009-01-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WY121T152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist