Individual
IVAN RUSSELL WHETTEN
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
O.D.
Contact information
Practice address
2624 COMMERCIAL WAY, STE B, ROCK SPRINGS, WY 82901-4769
(307) 382-3753
Mailing address
2624 COMMERICAL WAY STE B, ROCK SPRINGS, WY 82901-4769
(307) 382-3753
Taxonomy
Speciality
Code
Description
License number
State
152W00000X
Optometrist
Primary
400T
WY
Other
Enumeration date
07/23/2015
Last updated
08/11/2015
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