Provider Demographics
NPI:1508141995
Name:FRONTIER EYE CARE LLC
Entity Type:Organization
Organization Name:FRONTIER EYE CARE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OPTOMETRIST
Authorized Official - Prefix:DR
Authorized Official - First Name:DOUGLAS
Authorized Official - Middle Name:JOHN
Authorized Official - Last Name:HODGSON
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:307-277-5282
Mailing Address - Street 1:PO BOX 50871
Mailing Address - Street 2:
Mailing Address - City:CASPER
Mailing Address - State:WY
Mailing Address - Zip Code:82605-0871
Mailing Address - Country:US
Mailing Address - Phone:307-277-5282
Mailing Address - Fax:
Practice Address - Street 1:5880 E 2ND ST STE 100
Practice Address - Street 2:
Practice Address - City:CASPER
Practice Address - State:WY
Practice Address - Zip Code:82609-4389
Practice Address - Country:US
Practice Address - Phone:307-472-2020
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-10-17
Last Update Date:2016-10-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WY268T152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
WY132819100Medicaid