Healthcare Provider Details

I. General information

NPI: 1992693113
Provider Name (Legal Business Name): WYOMING VISION COLLECTIVE DESERT VIEW EYE CARE
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/26/2025
Last Update Date: 08/27/2025
Certification Date: 08/27/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

170 COMMERCE DR STE C
GREEN RIVER WY
82935-6156
US

IV. Provider business mailing address

170 COMMERCE DR STE C
GREEN RIVER WY
82935-6156
US

V. Phone/Fax

Practice location:
  • Phone: 307-875-3399
  • Fax: 307-875-3778
Mailing address:
  • Phone: 307-875-3399
  • Fax: 307-875-3778

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code152W00000X
TaxonomyOptometrist
License Number
License Number State

VIII. Authorized Official

Name: HALEIGH ROBERTSON
Title or Position: MINORITY OWNER/OFFICE MANAGER
Credential:
Phone: 307-371-3627