Individual
ALISA K STEWART
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
OPTICIAN
Contact information
Practice address
424 YELLOWSTONE AVE, SUITE 110, CODY, WY 82414-9318
(307) 587-5788
Mailing address
424 YELLOWSTONE AVE, SUITE 110, CODY, WY 82414-9318
(307) 587-5788
Taxonomy
Speciality
Code
Description
License number
State
152W00000X
Optometrist
Primary
156FX1800X
WY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
113960600
—
WY
Enumeration date
07/22/2008
Last updated
10/06/2011
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