Provider Demographics
NPI:1306282462
Name:SPECTUS RLLP
Entity type:Organization
Organization Name:SPECTUS RLLP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGING PARTNER
Authorized Official - Prefix:DR
Authorized Official - First Name:NICK
Authorized Official - Middle Name:J
Authorized Official - Last Name:BRATTIS
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:307-266-2020
Mailing Address - Street 1:400 E 1ST ST
Mailing Address - Street 2:SUITE 314
Mailing Address - City:CASPER
Mailing Address - State:WY
Mailing Address - Zip Code:82601-2561
Mailing Address - Country:US
Mailing Address - Phone:307-266-2020
Mailing Address - Fax:307-234-8074
Practice Address - Street 1:400 E 1ST ST
Practice Address - Street 2:SUITE 314
Practice Address - City:CASPER
Practice Address - State:WY
Practice Address - Zip Code:82601-2561
Practice Address - Country:US
Practice Address - Phone:307-266-2020
Practice Address - Fax:307-234-8074
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-05-16
Last Update Date:2013-06-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WY120-T152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
WY104085500Medicaid
301361OtherBLUE CROSS KID CARE
P00075662OtherMEDICARE-RAILROAD (PALAMETTO)
4591070Medicare PIN
WY104085500Medicaid