Provider Demographics
NPI:1164572897
Name:WYOMING CENTER FOR SIGHT P.C.
Entity Type:Organization
Organization Name:WYOMING CENTER FOR SIGHT P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:MATTHEW
Authorized Official - Middle Name:TAYLOR
Authorized Official - Last Name:DODDS
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:307-237-2511
Mailing Address - Street 1:1421 WILKINS CIR
Mailing Address - Street 2:
Mailing Address - City:CASPER
Mailing Address - State:WY
Mailing Address - Zip Code:82601-1337
Mailing Address - Country:US
Mailing Address - Phone:307-237-2511
Mailing Address - Fax:307-237-7351
Practice Address - Street 1:1421 WILKINS CIR
Practice Address - Street 2:
Practice Address - City:CASPER
Practice Address - State:WY
Practice Address - Zip Code:82601-1337
Practice Address - Country:US
Practice Address - Phone:307-237-2511
Practice Address - Fax:307-237-7351
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-12
Last Update Date:2011-06-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WY4462A174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
WY108875100Medicaid
WY00938001OtherBLUE CROSS BLUE SHIELD
WY108875100Medicaid