Dubois Vision Center

Primary specialty

OptometristTaxonomy code 152W00000X

License

118T Issued in WY

Legal business name

DUBOIS VISION CENTER

Practice address

1203 W Ramshorn Dr
Dubois, WY 82513-0480

Phone

(307) 455-2125

Fax

(307) 856-8548

NPI assigned

Aug 19, 2005

Last updated

Jul 8, 2010By the provider in NPPES

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Mr. Brian J Ballard, O.D.NPI 1114919826

Title

Owner/Optometrist

Phone

(307) 856-9451

Specialties & licenses 1

Addresses

Other identifiers 2

Medicare fee-for-service enrollment

Enrolled in WY

Enrollment records 1

Practitioners 2

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

• Christopher C Frazier, OD

  • Optometrist
  • Riverton, WY
  • NPI 1841302189
  Medicare reassignment NPD
• Brian J Ballard, O.D.

  • Optometrist
  • Riverton, WY
  • NPI 1114919826
  Authorized official Same address or phone

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1124409600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1278547200000",
    "number": "1073505699",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 480",
            "city": "DUBOIS",
            "state": "WY",
            "postal_code": "825130480",
            "telephone_number": "307-455-2125",
            "fax_number": "307-856-8548"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1203 W RAMSHORN DR",
            "city": "DUBOIS",
            "state": "WY",
            "postal_code": "825130480",
            "telephone_number": "307-455-2125",
            "fax_number": "307-856-8548"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "DUBOIS VISION CENTER",
        "organizational_subpart": "NO",
        "enumeration_date": "2005-08-19",
        "last_updated": "2010-07-08",
        "status": "A",
        "authorized_official_last_name": "BALLARD",
        "authorized_official_first_name": "BRIAN",
        "authorized_official_middle_name": "J",
        "authorized_official_title_or_position": "OWNER/OPTOMETRIST",
        "authorized_official_telephone_number": "307-856-9451",
        "authorized_official_name_prefix": "Mr.",
        "authorized_official_credential": "O.D."
    },
    "taxonomies": [
        {
            "code": "152W00000X",
            "taxonomy_group": "",
            "desc": "Optometrist",
            "state": "WY",
            "license": "118T",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "CIGNA MEDICARE",
            "identifier": "0762340001",
            "state": "WI"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "104136300",
            "state": "WY"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Paul T Beisser III, CRNA
• Christen Shealeen Boyle, PTA
• Community Health Center of Central Wyoming Inc (Dubois Medical Clinic)
• Dubois Assisted Living, Inc
• Linda Carol Eckley, R.N.
• Guardian Flight LLC
• Stacy M Hutchins, RN
• Kristen Kohlbrand, NP
• William Ervin Lemke, PHYSICAL THERAPIST

• Optometrist in Dubois, WY
• Providers in Dubois, WY by specialty
• Optometrist in Wyoming

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 8, 2010; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.