Provider Demographics
NPI:1083833883
Name:CHEYENNE OCULAR SURGERY
Entity Type:Organization
Organization Name:CHEYENNE OCULAR SURGERY
Other - Org Name:CHEYENNE EYE SURGERY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:DIRK
Authorized Official - Middle Name:
Authorized Official - Last Name:DIJKSTAL
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:307-634-2020
Mailing Address - Street 1:1300 E 20TH ST
Mailing Address - Street 2:
Mailing Address - City:CHEYENNE
Mailing Address - State:WY
Mailing Address - Zip Code:82001-4021
Mailing Address - Country:US
Mailing Address - Phone:307-634-2020
Mailing Address - Fax:
Practice Address - Street 1:1300 E 20TH ST
Practice Address - Street 2:
Practice Address - City:CHEYENNE
Practice Address - State:WY
Practice Address - Zip Code:82001-4021
Practice Address - Country:US
Practice Address - Phone:307-634-2020
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-24
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QA1903XAmbulatory Health Care FacilitiesClinic/CenterAmbulatory Surgical