Provider Demographics
NPI:1225254204
Name:ALBANY EYE CARE, LLC
Entity Type:Organization
Organization Name:ALBANY EYE CARE, LLC
Other - Org Name:ALBANY EYE CARE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CFO
Authorized Official - Prefix:DR
Authorized Official - First Name:EVERETT
Authorized Official - Middle Name:L
Authorized Official - Last Name:KING
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:307-745-8554
Mailing Address - Street 1:418 S 5TH ST
Mailing Address - Street 2:
Mailing Address - City:LARAMIE
Mailing Address - State:WY
Mailing Address - Zip Code:82070-3733
Mailing Address - Country:US
Mailing Address - Phone:307-745-8554
Mailing Address - Fax:307-755-5929
Practice Address - Street 1:418 S 5TH ST
Practice Address - Street 2:
Practice Address - City:LARAMIE
Practice Address - State:WY
Practice Address - Zip Code:82070-3733
Practice Address - Country:US
Practice Address - Phone:307-745-8554
Practice Address - Fax:307-755-5929
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-18
Last Update Date:2009-07-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WYWYO143152WC0802X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152WC0802XEye and Vision Services ProvidersOptometristCorneal and Contact ManagementGroup - Single Specialty