Individual
PAUL B COLBURN
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
O.D.
Contact information
Practice address
3726 AVENUE D, SCOTTSBLUFF, NE 69361-4665
(308) 635-1234
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
193T
WY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
103409000
—
WY
01
—
310523
BCBS WY PROVIDER NUMBER
WY
01
—
4100004467
RR MEDICARE PROVIDER NUMB
WY
Enumeration date
12/14/2006
Last updated
07/07/2022
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