=====================================================
General NPI Number Information
=====================================================
NPI Number | 1326102740
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | EYE INSTITUTE OF WYOMING
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 12/20/2006
-----------------------------------------------------
Last Update Date | 08/07/2024
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 301 S FENWAY ST SUITE 102
-----------------------------------------------------
City | CASPER
-----------------------------------------------------
State | WY
-----------------------------------------------------
Zip | 82601-3051
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 307-235-5384
-----------------------------------------------------
Fax | 307-265-7500
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 301 S FENWAY ST SUITE 102
-----------------------------------------------------
City | CASPER
-----------------------------------------------------
State | WY
-----------------------------------------------------
Zip | 82601-3051
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 307-235-5384
-----------------------------------------------------
Fax | 307-265-7500
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | PRESIDENT
-----------------------------------------------------
Name | DR. DANA LYDELL DAY
-----------------------------------------------------
Credential | O.D.
-----------------------------------------------------
Telephone | 307-235-5384
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 152W00000X
-----------------------------------------------------
Taxonomy Name | Optometrist
-----------------------------------------------------
License Number | 260T
-----------------------------------------------------
License Number State | WY
-----------------------------------------------------