Provider Demographics
NPI:1790235133
Name:WYOVISION ASSOCIATES OF GILLETTE LLC
Entity Type:Organization
Organization Name:WYOVISION ASSOCIATES OF GILLETTE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:JOSEPH
Authorized Official - Middle Name:V
Authorized Official - Last Name:KATSCHKE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:307-673-5177
Mailing Address - Street 1:530 RUNNING W DR STE 110
Mailing Address - Street 2:
Mailing Address - City:GILLETTE
Mailing Address - State:WY
Mailing Address - Zip Code:82718-2074
Mailing Address - Country:US
Mailing Address - Phone:307-682-2747
Mailing Address - Fax:307-686-9984
Practice Address - Street 1:530 RUNNING W DR STE 110
Practice Address - Street 2:
Practice Address - City:GILLETTE
Practice Address - State:WY
Practice Address - Zip Code:82718-2074
Practice Address - Country:US
Practice Address - Phone:307-682-2747
Practice Address - Fax:307-333-0215
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-10-10
Last Update Date:2020-04-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WY318T152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty