Organization
MUD SPRINGS VISION CLINIC, INC.
Active
Organization subpart
No
Provider details
NPI number
Authorized official
JAIME A HAZEN O.D. (OWNER)
(307) 322-9747
Entity
Organization
Contact information
Practice address
404 9TH ST, WHEATLAND, WY 82201-2910
(307) 322-9747
(307) 322-9776
Mailing address
404 9TH ST, WHEATLAND, WY 82201-2910
(307) 322-9747
(307) 322-9776
Taxonomy
Speciality
Code
Description
License number
State
152W00000X
Optometrist
Primary
340T
WY
Other
Enumeration date
11/20/2012
Last updated
11/20/2012
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