Individual
WAYNE HUDSON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Contact information
Practice address
124 N 4TH ST, DOUGLAS, WY 82633-2402
(307) 358-9008
(307) 358-5183
Mailing address
124 N 4TH ST, DOUGLAS, WY 82633-2402
Taxonomy
Speciality
Code
Description
License number
State
152W00000X
Optometrist
Primary
128T
WY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
114737400
—
WY
Enumeration date
05/08/2006
Last updated
08/27/2010
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