Healthcare Provider Details

I. General information

NPI: 1285810721
Provider Name (Legal Business Name): CHEYENNE HEARING CLINIC INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/15/2008
Last Update Date: 04/01/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1401 AIRPORT PARKWAY #230
CHEYENNE WY
82001-1693
US

IV. Provider business mailing address

1401 AIRPORT PARKWAY #230
CHEYENNE WY
82001-1693
US

V. Phone/Fax

Practice location:
  • Phone: 307-635-0435
  • Fax: 307-432-0531
Mailing address:
  • Phone: 307-635-0435
  • Fax: 307-432-0531

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code332S00000X
TaxonomyHearing Aid Equipment
License NumberA909
License Number StateWY
# 2
Primary TaxonomyY
Taxonomy Code231H00000X
TaxonomyAudiologist
License NumberA909
License Number StateWY

VIII. Authorized Official

Name: MR. ARLAN EARL WALTER
Title or Position: OWNER PRESIDENT
Credential: MS MASTER OF SCIENCE
Phone: 307-635-0435