Provider Demographics
NPI:1780689067
Name:DAY, DANA LYDELL (OD)
Entity Type:Individual
Prefix:DR
First Name:DANA
Middle Name:LYDELL
Last Name:DAY
Suffix:
Gender:M
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:301 S FENWAY ST
Mailing Address - Street 2:STE 102
Mailing Address - City:CASPER
Mailing Address - State:WY
Mailing Address - Zip Code:82601-3049
Mailing Address - Country:US
Mailing Address - Phone:307-235-5384
Mailing Address - Fax:307-265-7500
Practice Address - Street 1:301 S FENWAY ST
Practice Address - Street 2:STE 102
Practice Address - City:CASPER
Practice Address - State:WY
Practice Address - Zip Code:82601-3049
Practice Address - Country:US
Practice Address - Phone:307-235-5384
Practice Address - Fax:307-265-7500
Is Sole Proprietor?:No
Enumeration Date:2005-06-14
Last Update Date:2007-10-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WY260T152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
WY114199600Medicaid
WY114199600Medicaid
WY307994Medicare ID - Type Unspecified
WYU70590Medicare UPIN
WYWY9856Medicare ID - Type Unspecified