Provider Demographics
NPI:1215928429
Name:NORTHERN WYOMING OPHTHALMOLOGY, P.C.
Entity type:Organization
Organization Name:NORTHERN WYOMING OPHTHALMOLOGY, P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:BARRY
Authorized Official - Middle Name:P
Authorized Official - Last Name:WELCH
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:307-587-5538
Mailing Address - Street 1:424 YELLOWSTONE AVE
Mailing Address - Street 2:SUITE 110
Mailing Address - City:CODY
Mailing Address - State:WY
Mailing Address - Zip Code:82414-9318
Mailing Address - Country:US
Mailing Address - Phone:307-587-5538
Mailing Address - Fax:
Practice Address - Street 1:424 YELLOWSTONE AVE
Practice Address - Street 2:SUITE 110
Practice Address - City:CODY
Practice Address - State:WY
Practice Address - Zip Code:82414-9318
Practice Address - Country:US
Practice Address - Phone:307-587-5538
Practice Address - Fax:307-587-4896
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-11-04
Last Update Date:2012-10-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
WY04698001OtherBLUE CROSS BLUE SHEILD
WY110675900Medicaid
WY04698001OtherBLUE CROSS BLUE SHEILD