Provider Demographics
NPI:1992736813
Name:DESERT VIEW EYE CARE, LC
Entity type:Organization
Organization Name:DESERT VIEW EYE CARE, LC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/MANAGER
Authorized Official - Prefix:DR
Authorized Official - First Name:JEFFREY
Authorized Official - Middle Name:A
Authorized Official - Last Name:WILSON
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:307-875-3399
Mailing Address - Street 1:170 COMMERCE DR STE C
Mailing Address - Street 2:
Mailing Address - City:GREEN RIVER
Mailing Address - State:WY
Mailing Address - Zip Code:82935-6156
Mailing Address - Country:US
Mailing Address - Phone:307-875-3399
Mailing Address - Fax:307-875-3778
Practice Address - Street 1:170 COMMERCE DR STE C
Practice Address - Street 2:
Practice Address - City:GREEN RIVER
Practice Address - State:WY
Practice Address - Zip Code:82935-6156
Practice Address - Country:US
Practice Address - Phone:307-875-3399
Practice Address - Fax:307-875-3778
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-06
Last Update Date:2023-12-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WY297T152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
WY5993300001Medicare NSC