Provider Demographics
NPI:1558675702
Name:THE EYE INSTITUTE PC
Entity Type:Organization
Organization Name:THE EYE INSTITUTE PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DOCTOR
Authorized Official - Prefix:
Authorized Official - First Name:RANDY
Authorized Official - Middle Name:L
Authorized Official - Last Name:FUJA
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:307-362-4202
Mailing Address - Street 1:2631 FOOTHILL BLVD STE A
Mailing Address - Street 2:
Mailing Address - City:ROCK SPRINGS
Mailing Address - State:WY
Mailing Address - Zip Code:82901-4770
Mailing Address - Country:US
Mailing Address - Phone:307-362-4202
Mailing Address - Fax:307-362-4332
Practice Address - Street 1:2631 FOOTHILL BLVD STE A
Practice Address - Street 2:
Practice Address - City:ROCK SPRINGS
Practice Address - State:WY
Practice Address - Zip Code:82901-4770
Practice Address - Country:US
Practice Address - Phone:307-362-4202
Practice Address - Fax:307-362-4332
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-07-29
Last Update Date:2010-07-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WY214T152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty