Healthcare Provider Details

I. General information

NPI: 1982755096
Provider Name (Legal Business Name): CENTRAL WYOMING EYE CLINIC, PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/15/2007
Last Update Date: 11/04/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1705 E 12TH ST
CASPER WY
82601-4038
US

IV. Provider business mailing address

1705 E 12TH ST
CASPER WY
82601-4038
US

V. Phone/Fax

Practice location:
  • Phone: 307-235-4185
  • Fax: 307-235-4127
Mailing address:
  • Phone: 307-235-4185
  • Fax: 307-235-4127

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QM2500X
TaxonomyMedical Specialty Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: DR. RONALD EUGENE GIBSON
Title or Position: PRESIDENT
Credential: M.D.
Phone: 307-235-4185