Healthcare Provider Details

I. General information

NPI: 1326247479
Provider Name (Legal Business Name): CHEYENNE OCULAR SURGERY
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/17/2007
Last Update Date: 12/12/2025
Certification Date: 12/12/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1300 E 20TH ST
CHEYENNE WY
82001-4021
US

IV. Provider business mailing address

1300 E 20TH ST
CHEYENNE WY
82001-4021
US

V. Phone/Fax

Practice location:
  • Phone: 307-632-2020
  • Fax:
Mailing address:
  • Phone: 307-632-2020
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QA1903X
TaxonomyAmbulatory Surgical Clinic/Center
License Number10141
License Number StateWY

VIII. Authorized Official

Name: LAURA M GARCIA
Title or Position: VP REVENUE CYCLE MANAGEMENT
Credential:
Phone: 949-615-9288