Provider Demographics
NPI:1922582402
Name:WYOMING EYE SURGEONS
Entity Type:Organization
Organization Name:WYOMING EYE SURGEONS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:BAIRN
Authorized Official - Middle Name:MICHAEL
Authorized Official - Last Name:WALKER
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:559-246-8254
Mailing Address - Street 1:23 MOONLIGHT DR
Mailing Address - Street 2:
Mailing Address - City:SHERIDAN
Mailing Address - State:WY
Mailing Address - Zip Code:82801-8627
Mailing Address - Country:US
Mailing Address - Phone:559-246-8254
Mailing Address - Fax:
Practice Address - Street 1:36 N. GOULD ST.
Practice Address - Street 2:SUITE 2A
Practice Address - City:SHERIDAN
Practice Address - State:WY
Practice Address - Zip Code:82801
Practice Address - Country:US
Practice Address - Phone:559-246-8254
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-09-20
Last Update Date:2019-10-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00984070Medicaid