Provider Demographics
NPI:1942345277
Name:RODGERS, DAVID WAYNE (OD)
Entity Type:Individual
Prefix:DR
First Name:DAVID
Middle Name:WAYNE
Last Name:RODGERS
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 1:278 MAIN ST
Mailing Address - Street 2:
Mailing Address - City:LANDER
Mailing Address - State:WY
Mailing Address - Zip Code:82520-3128
Mailing Address - Country:US
Mailing Address - Phone:307-332-7284
Mailing Address - Fax:307-332-7285
Practice Address - Street 1:278 MAIN ST
Practice Address - Street 2:
Practice Address - City:LANDER
Practice Address - State:WY
Practice Address - Zip Code:82520-3128
Practice Address - Country:US
Practice Address - Phone:307-332-7284
Practice Address - Fax:307-332-7285
Is Sole Proprietor?:No
Enumeration Date:2007-02-21
Last Update Date:2008-04-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WY216T152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
WY307050OtherBCBS OF WY PROVIDER
WY1200330001Medicare NSC
WYU48204Medicare UPIN
WYW21177Medicare PIN