=====================================================
General NPI Number Information
=====================================================
NPI Number | 1922293158
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | CENTRAL WYOMING OPTOMETRIC CENTER PC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 09/11/2007
-----------------------------------------------------
Last Update Date | 05/28/2013
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 1111 S. MCKINLEY
-----------------------------------------------------
City | CASPER
-----------------------------------------------------
State | WY
-----------------------------------------------------
Zip | 82601
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 307-235-3144
-----------------------------------------------------
Fax | 307-473-4073
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 1111 S. MCKINLEY
-----------------------------------------------------
City | CASPER
-----------------------------------------------------
State | WY
-----------------------------------------------------
Zip | 82601
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 307-235-3144
-----------------------------------------------------
Fax | 307-473-4073
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OWNER/PRESIDENT
-----------------------------------------------------
Name | MR. DEON K ZEITNER
-----------------------------------------------------
Credential | O.D
-----------------------------------------------------
Telephone | 307-235-3144
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 152W00000X
-----------------------------------------------------
Taxonomy Name | Optometrist
-----------------------------------------------------
License Number | 215T
-----------------------------------------------------
License Number State | WY
-----------------------------------------------------