Provider Demographics
NPI:1952458499
Name:BEVERLY NOTT, OD PC
Entity Type:Organization
Organization Name:BEVERLY NOTT, OD PC
Other - Org Name:HIGH PLAINS VISION CENTER SARATOGA
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OPTOMETRIST
Authorized Official - Prefix:
Authorized Official - First Name:BEVERLY
Authorized Official - Middle Name:
Authorized Official - Last Name:NOTT
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:307-326-8714
Mailing Address - Street 1:PO BOX 25
Mailing Address - Street 2:
Mailing Address - City:SARATOGA
Mailing Address - State:WY
Mailing Address - Zip Code:82331-0025
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:1210 S RIVER ST
Practice Address - Street 2:
Practice Address - City:SARATOGA
Practice Address - State:WY
Practice Address - Zip Code:82331-0025
Practice Address - Country:US
Practice Address - Phone:307-326-8714
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-05
Last Update Date:2008-01-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WY283T152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
WY20305Medicare ID - Type Unspecified
WY4958110001Medicare NSC