Provider Demographics
NPI:1437379161
Name:WYOMING OPTICAL INC
Entity Type:Organization
Organization Name:WYOMING OPTICAL INC
Other - Org Name:WYOMING OPTICAL THE EYEGLASS FACTORY
Other - Org Type:Other Name
Authorized Official - Title/Position:SEC TREA
Authorized Official - Prefix:MRS
Authorized Official - First Name:CAROL
Authorized Official - Middle Name:M
Authorized Official - Last Name:FRICK
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:307-265-4324
Mailing Address - Street 1:485 E 2ND ST
Mailing Address - Street 2:
Mailing Address - City:CASPER
Mailing Address - State:WY
Mailing Address - Zip Code:82601-2507
Mailing Address - Country:US
Mailing Address - Phone:307-265-4324
Mailing Address - Fax:307-234-0144
Practice Address - Street 1:485 E 2ND ST
Practice Address - Street 2:
Practice Address - City:CASPER
Practice Address - State:WY
Practice Address - Zip Code:82601-2507
Practice Address - Country:US
Practice Address - Phone:307-265-4324
Practice Address - Fax:307-234-0144
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-26
Last Update Date:2010-05-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes156FX1800XEye and Vision Services ProvidersTechnician/TechnologistOpticianGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
WY303831OtherKIDCARE
WY106119400Medicaid
0756750001Medicare PIN