Healthcare Provider Details

I. General information

NPI: 1447562012
Provider Name (Legal Business Name): VISION AYUDA, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/12/2010
Last Update Date: 07/12/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1439 STILLWATER AVE SUITE 7
CHEYENNE WY
82009-7367
US

IV. Provider business mailing address

1439 STILLWATER AVE SUITE 7
CHEYENNE WY
82009-7367
US

V. Phone/Fax

Practice location:
  • Phone: 307-778-7100
  • Fax:
Mailing address:
  • Phone: 307-778-7100
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223P0221X
TaxonomyPediatric Dentistry
License Number1245
License Number StateWY

VIII. Authorized Official

Name: MATTHEW HENRY
Title or Position: OWNER
Credential: DDS
Phone: 907-854-3244