Provider Demographics
NPI:1407801137
Name:FAMILY VISION AND CONTACT LENS CLINIC, LLC
Entity Type:Organization
Organization Name:FAMILY VISION AND CONTACT LENS CLINIC, LLC
Other - Org Name:FAMILY VISION AND CONTACT LENS CLINIC, LLC
Other - Org Type:Former Legal Business Name
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:EMILY
Authorized Official - Middle Name:MEIHAK
Authorized Official - Last Name:STICKELBERGER
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:307-237-8713
Mailing Address - Street 1:1328 E 12TH ST
Mailing Address - Street 2:
Mailing Address - City:CASPER
Mailing Address - State:WY
Mailing Address - Zip Code:82601-3912
Mailing Address - Country:US
Mailing Address - Phone:307-237-8713
Mailing Address - Fax:307-237-5740
Practice Address - Street 1:1328 E 12TH ST
Practice Address - Street 2:
Practice Address - City:CASPER
Practice Address - State:WY
Practice Address - Zip Code:82601-3912
Practice Address - Country:US
Practice Address - Phone:307-237-8713
Practice Address - Fax:307-237-5740
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-23
Last Update Date:2023-04-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WY127T152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
WY410036494OtherRAIL ROAD MEDICARE
WY122595200Medicaid
WY410036494OtherRAIL ROAD MEDICARE
WY122595200Medicaid