Provider Demographics
NPI:1902390974
Name:CHEYENNE EYE CLINIC, LLC
Entity Type:Organization
Organization Name:CHEYENNE EYE CLINIC, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CLINIC MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:STACEY
Authorized Official - Middle Name:
Authorized Official - Last Name:OSTBY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:307-634-2020
Mailing Address - Street 1:1300 E 20TH ST
Mailing Address - Street 2:
Mailing Address - City:CHEYENNE
Mailing Address - State:WY
Mailing Address - Zip Code:82001-4021
Mailing Address - Country:US
Mailing Address - Phone:307-634-2020
Mailing Address - Fax:307-635-6510
Practice Address - Street 1:1300 E 20TH ST
Practice Address - Street 2:
Practice Address - City:CHEYENNE
Practice Address - State:WY
Practice Address - Zip Code:82001
Practice Address - Country:US
Practice Address - Phone:307-634-2020
Practice Address - Fax:307-635-6510
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-06-21
Last Update Date:2018-06-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmologyGroup - Single Specialty