Provider Demographics
NPI:1326102740
Name:EYE INSTITUTE OF WYOMING
Entity type:Organization
Organization Name:EYE INSTITUTE OF WYOMING
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:DANA
Authorized Official - Middle Name:LYDELL
Authorized Official - Last Name:DAY
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:307-235-5384
Mailing Address - Street 1:301 S FENWAY ST
Mailing Address - Street 2:SUITE 102
Mailing Address - City:CASPER
Mailing Address - State:WY
Mailing Address - Zip Code:82601-3051
Mailing Address - Country:US
Mailing Address - Phone:307-235-5384
Mailing Address - Fax:307-265-7500
Practice Address - Street 1:301 S FENWAY ST
Practice Address - Street 2:SUITE 102
Practice Address - City:CASPER
Practice Address - State:WY
Practice Address - Zip Code:82601-3051
Practice Address - Country:US
Practice Address - Phone:307-235-5384
Practice Address - Fax:307-265-7500
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-20
Last Update Date:2024-08-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WY260T152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
WY114199600Medicaid