Organization
SCOTTSBLUFF VISION CLINIC P C
Active
Other names
Eastern Wyoming Eye Clinic
Organization subpart
No
Provider details
NPI number
Authorized official
PAUL B COLBURN O.D. (PRESIDENT)
(307) 532-2060
Entity
Organization
Contact information
Practice address
520 COLLEGE DR, TORRINGTON, WY 82240-1517
(307) 532-2060
(307) 532-5710
Mailing address
520 COLLEGE DR, TORRINGTON, WY 82240-1517
(307) 532-2060
(307) 532-5710
Taxonomy
Speciality
Code
Description
License number
State
152W00000X
Optometrist
Primary
123T
WY
152W00000X
Optometrist
174T
WY
152W00000X
Optometrist
193T
WY
152W00000X
Optometrist
316T
WY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
0027001
BCBS WY SUBMITTER ID
WY
05
—
102711500
—
WY
Enumeration date
12/14/2006
Last updated
10/03/2024
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