Provider Demographics
NPI:1861527178
Name:BRATTIS, NICHOLAS JAMES (OD)
Entity type:Individual
Prefix:DR
First Name:NICHOLAS
Middle Name:JAMES
Last Name:BRATTIS
Suffix:
Gender:M
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
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:82601-2558
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:82601-2558
Practice Address - Country:US
Practice Address - Phone:307-266-2020
Practice Address - Fax:307-234-8074
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-23
Last Update Date:2013-05-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WY120-T152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
WY301361OtherBLUE CROSS KID CARE
4591070OtherPIN
WY104085500Medicaid
4591070OtherPIN
P00075662Medicare ID - Type UnspecifiedRAILROAD (PALAMETTO)