Organization
DUBOIS VISION CENTER
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MR. BRIAN J BALLARD O.D. (OWNER/OPTOMETRIST)
(307) 856-9451
Entity
Organization
Contact information
Practice address
1203 W RAMSHORN DR, DUBOIS, WY 82513-0480
(307) 455-2125
(307) 856-8548
Mailing address
PO BOX 480, DUBOIS, WY 82513-0480
(307) 455-2125
(307) 856-8548
Taxonomy
Speciality
Code
Description
License number
State
152W00000X
Optometrist
Primary
118T
WY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
0762340001
CIGNA MEDICARE
WI
05
—
104136300
—
WY
Enumeration date
08/19/2005
Last updated
07/08/2010
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