Provider Demographics
NPI:1750679965
Name:CARL C. COTTRELL, O.D.
Entity Type:Organization
Organization Name:CARL C. COTTRELL, O.D.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/OPTOMETRIST
Authorized Official - Prefix:DR
Authorized Official - First Name:CARL
Authorized Official - Middle Name:C
Authorized Official - Last Name:COTTRELL
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:307-347-6141
Mailing Address - Street 1:820 COBURN AVE
Mailing Address - Street 2:
Mailing Address - City:WORLAND
Mailing Address - State:WY
Mailing Address - Zip Code:82401-3317
Mailing Address - Country:US
Mailing Address - Phone:307-347-6141
Mailing Address - Fax:307-347-6142
Practice Address - Street 1:820 COBURN AVE
Practice Address - Street 2:
Practice Address - City:WORLAND
Practice Address - State:WY
Practice Address - Zip Code:82401-3317
Practice Address - Country:US
Practice Address - Phone:307-347-6141
Practice Address - Fax:307-347-6142
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-07-21
Last Update Date:2020-12-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WY255T152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
WY1134451-00Medicaid
WY1134451-00Medicaid
WYW307683Medicare PIN