Scottsbluff Vision Clinic P C
Organization Active NPI Optometrist · Torrington, WY
NPI 1487716668 · NPPES record last updated Oct 3, 2024
Key facts
- NPI
- 1487716668
- Entity type
- Organization (NPI type 2)
- Primary specialty
- Optometrist 152W00000X
- License
- 123T (WY)
- Legal business name
- SCOTTSBLUFF VISION CLINIC P C
- Practice address
- 520 College Dr
Torrington, WY 82240-1517 - Phone
- (307) 532-2060
- Fax
- (307) 532-5710
- NPI assigned
- Dec 14, 2006
- Organization subpart
- No
Authorized official
- Name
- Paul B Colburn, O.D.
- Title
- President
- Phone
- (307) 532-2060
Other NPIs with the same Medicare PAC ID 1
Corporate family (same tax ID) 1
Practitioners 4
-
Paul B Colburn, O.D.
-
Natasha K Jenkins, O.D.
-
John Todd Mahoney, O.D.
Laboratory certificates & supplier records
Medicare medical equipment & supply locations
| Supplier | Supplies | Medicare assignment |
|---|---|---|
| Scottsbluff Vision Clinic PC |
Prosthetic Lenses: Conventional Eyeglasses|Prosthetic Lenses: Conventional Contact Lenses | Accepts assignment |
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled (2 enrollments) in WY
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| O20040603001092 | WY | Part B Supplier - Clinic/Group Practice | 9931181880 |
Receives reassigned benefits from 4 practitioners Practice locations: Torrington, WY |
| O20100930089049 | WY | DME Supplier - Physician - Optometrist | 9931181880 | Practice locations: Torrington, WY |
National Provider Directory
- Tax ID family
- NG Eye CL Eastern Wyomi
Locations
3726 Avenue D
Scottsbluff, NE 69361
Phone (308) 635-1234
520 College Dr
Torrington, WY 82240
Phone (307) 532-2060
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Optometrist |
152W00000X | 123T | WY | Yes |
| Optometrist |
152W00000X | 193T | WY | |
| Optometrist |
152W00000X | 316T | WY | |
| Optometrist |
152W00000X | 174T | WY |
Addresses
Primary practice location
520 College Dr
Torrington, WY 82240-1517
Mailing address
520 College Dr
Torrington, WY 82240-1517
Phone (307) 532-2060
Other identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 0027001 | Other | WY | BCBS WY SUBMITTER ID |
| 102711500 | Medicaid | WY |
Other names
- Eastern Wyoming Eye Clinic
Other providers in Torrington, WY
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Oct 3, 2024. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- Medicare Care Compare provider data (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.