Individual
DR. JACOB G DESPAIN
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
O.D.
Contact information
Practice address
1708 STAMPEDE AVE, CODY, WY 82414-4829
(307) 587-2404
(307) 527-7368
Mailing address
1708 STAMPEDE AVE, CODY, WY 82414-4829
(307) 587-2404
(307) 527-7368
Taxonomy
Speciality
Code
Description
License number
State
152W00000X
Optometrist
Primary
327T
WY
152W00000X
Optometrist
OD60035926
WA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
135237700
—
WY
01
—
W25396
PTAN
WY
Enumeration date
07/31/2008
Last updated
09/27/2013
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