Provider Demographics
NPI:1922133677
Name:ADVANCED EYE CARE CLINIC PC
Entity Type:Organization
Organization Name:ADVANCED EYE CARE CLINIC PC
Other - Org Name:ADVANCED EYE CLINIC PC
Other - Org Type:Former Legal Business Name
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:CARLYLE
Authorized Official - Last Name:ELDRED
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:307-638-2020
Mailing Address - Street 1:2029 BLUEGRASS CIR
Mailing Address - Street 2:
Mailing Address - City:CHEYENNE
Mailing Address - State:WY
Mailing Address - Zip Code:82009-7368
Mailing Address - Country:US
Mailing Address - Phone:307-638-2020
Mailing Address - Fax:307-634-0939
Practice Address - Street 1:2029 BLUEGRASS CIR
Practice Address - Street 2:
Practice Address - City:CHEYENNE
Practice Address - State:WY
Practice Address - Zip Code:82009-7368
Practice Address - Country:US
Practice Address - Phone:307-638-2020
Practice Address - Fax:307-634-0939
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-22
Last Update Date:2011-08-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WY103T261QH0100X
WY250T261QH0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QH0100XAmbulatory Health Care FacilitiesClinic/CenterHealth Service