Provider Demographics
NPI:1447406269
Name:MICHAEL K. HUGHES, OD, LLC
Entity Type:Organization
Organization Name:MICHAEL K. HUGHES, OD, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OPTOMETRIST
Authorized Official - Prefix:
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:K
Authorized Official - Last Name:HUGHES
Authorized Official - Suffix:
Authorized Official - Credentials:O D
Authorized Official - Phone:307-682-2747
Mailing Address - Street 1:1103 E BOXELDER RD
Mailing Address - Street 2:SUITE F
Mailing Address - City:GILLETTE
Mailing Address - State:WY
Mailing Address - Zip Code:82718-5582
Mailing Address - Country:US
Mailing Address - Phone:307-682-2747
Mailing Address - Fax:307-686-9984
Practice Address - Street 1:1103 E BOXELDER RD
Practice Address - Street 2:SUITE F
Practice Address - City:GILLETTE
Practice Address - State:WY
Practice Address - Zip Code:82718-5582
Practice Address - Country:US
Practice Address - Phone:307-682-2747
Practice Address - Fax:307-686-9984
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-08-12
Last Update Date:2008-08-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WY129-T152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
WY115074000Medicaid
WYT44146Medicare UPIN
WY306543Medicare PIN