1437379161 NPI number — WYOMING OPTICAL INC

Table of content: (NPI 1437379161)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1437379161 NPI number — WYOMING OPTICAL INC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
WYOMING OPTICAL INC
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
6
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1437379161
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
05/12/2010
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
485 E 2ND ST
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
CASPER
Provider Business Mailing Address State Name:
WY
Provider Business Mailing Address Postal Code:
82601-2507
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
307-265-4324
Provider Business Mailing Address Fax Number:
307-234-0144

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
485 E 2ND ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
CASPER
Provider Business Practice Location Address State Name:
WY
Provider Business Practice Location Address Postal Code:
82601-2507
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
307-265-4324
Provider Business Practice Location Address Fax Number:
307-234-0144
Provider Enumeration Date:
04/26/2007

Additional Information

Authorized Official

Authorized Official Last Name:
FRICK
Authorized Official First Name:
CAROL
Authorized Official Middle Name:
M
Authorized Official Title or Position:
SEC TREA
Authorized Official Telephone Number:
307-265-4324

Provider Taxonomy Codes

  • Taxonomy code: 156FX1800X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 303831 . This is a "KIDCARE" identifier , issued by the state of ( WY ) . This identifiers is of the category "OTHER".
  • Identifier: 106119400 , issued by the state of ( WY ) . This identifiers is of the category "MEDICAID".




Copyright © 2007-2025 www.npivalidator.com