Provider Demographics
NPI:1023035854
Name:MCDERMOTT, DANA MICHELE (OD)
Entity Type:Individual
Prefix:DR
First Name:DANA
Middle Name:MICHELE
Last Name:MCDERMOTT
Suffix:
Gender:F
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:420 ARAPAHOE STREET
Mailing Address - Street 2:
Mailing Address - City:THERMOPOLIS
Mailing Address - State:WY
Mailing Address - Zip Code:82443-2708
Mailing Address - Country:US
Mailing Address - Phone:307-864-2324
Mailing Address - Fax:307-864-2330
Practice Address - Street 1:420 ARAPAHOE STREET
Practice Address - Street 2:
Practice Address - City:THERMOPOLIS
Practice Address - State:WY
Practice Address - Zip Code:82443-2708
Practice Address - Country:US
Practice Address - Phone:307-864-2324
Practice Address - Fax:307-864-2330
Is Sole Proprietor?:No
Enumeration Date:2006-07-17
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WY263T152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
WY11504720Medicaid
WY263TOtherSTATE LICENSE #
WY263TOtherSTATE LICENSE #
WYU80357Medicare UPIN
WY20670Medicare PIN
WY263TOtherSTATE LICENSE #