Provider Demographics
NPI:1386836302
Name:CLEAR IMAGE VISION CARE, P.C.
Entity Type:Organization
Organization Name:CLEAR IMAGE VISION CARE, P.C.
Other - Org Name:TREAT VISION CARE, P.C.
Other - Org Type:Former Legal Business Name
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:KIRBY
Authorized Official - Middle Name:T
Authorized Official - Last Name:TREAT
Authorized Official - Suffix:SR
Authorized Official - Credentials:OD
Authorized Official - Phone:307-347-4151
Mailing Address - Street 1:610 S 12TH ST
Mailing Address - Street 2:
Mailing Address - City:WORLAND
Mailing Address - State:WY
Mailing Address - Zip Code:82401-4007
Mailing Address - Country:US
Mailing Address - Phone:307-347-4151
Mailing Address - Fax:
Practice Address - Street 1:610 S 12TH ST
Practice Address - Street 2:
Practice Address - City:WORLAND
Practice Address - State:WY
Practice Address - Zip Code:82401-4007
Practice Address - Country:US
Practice Address - Phone:307-347-4151
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-08-14
Last Update Date:2009-01-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
WY6125280001Medicare NSC