Provider Demographics
NPI:1154571826
Name:WORTHAM VISION CARE,INC.
Entity type:Organization
Organization Name:WORTHAM VISION CARE,INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:AUDIOLOGIST/OWNER
Authorized Official - Prefix:MRS
Authorized Official - First Name:BILLIE
Authorized Official - Middle Name:S
Authorized Official - Last Name:WORTHAM
Authorized Official - Suffix:
Authorized Official - Credentials:MS,CCCA
Authorized Official - Phone:307-787-6123
Mailing Address - Street 1:PO BOX 429
Mailing Address - Street 2:
Mailing Address - City:LYMAN
Mailing Address - State:WY
Mailing Address - Zip Code:82937-0429
Mailing Address - Country:US
Mailing Address - Phone:307-787-6123
Mailing Address - Fax:307-787-3351
Practice Address - Street 1:106 S MAIN
Practice Address - Street 2:
Practice Address - City:LYMAN
Practice Address - State:WY
Practice Address - Zip Code:82937
Practice Address - Country:US
Practice Address - Phone:307-787-6123
Practice Address - Fax:307-787-3351
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-09-30
Last Update Date:2009-06-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WYT197152W00000X
WYA933231H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
No231H00000XSpeech, Language and Hearing Service ProvidersAudiologistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
WY102280600Medicaid
WYCN2934OtherRR MEDICARE
WY102280600Medicaid
WY0902350001Medicare NSC