Healthcare Provider Details

I. General information

NPI: 1942345277
Provider Name (Legal Business Name): DAVID WAYNE RODGERS O.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/21/2007
Last Update Date: 04/16/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

278 MAIN ST
LANDER WY
82520-3128
US

IV. Provider business mailing address

278 MAIN ST
LANDER WY
82520-3128
US

V. Phone/Fax

Practice location:
  • Phone: 307-332-7284
  • Fax: 307-332-7285
Mailing address:
  • Phone: 307-332-7284
  • Fax: 307-332-7285

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code152W00000X
TaxonomyOptometrist
License Number216T
License Number StateWY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: