Healthcare Provider Details

I. General information

NPI: 1427265180
Provider Name (Legal Business Name): EYE CARE CLINIC & OPTICAL LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/16/2007
Last Update Date: 09/03/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6228 YELLOWSTONE RD
CHEYENNE WY
82009-3432
US

IV. Provider business mailing address

6228 YELLOWSTONE RD
CHEYENNE WY
82009-3432
US

V. Phone/Fax

Practice location:
  • Phone: 307-778-2771
  • Fax: 307-634-5443
Mailing address:
  • Phone: 307-778-2771
  • Fax: 307-634-5443

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code332H00000X
TaxonomyEyewear Supplier
License Number
License Number State

VIII. Authorized Official

Name: DR. ROBERT LEE HOLLY
Title or Position: MANAGING PARTNER
Credential: OD
Phone: 307-778-2771