Provider Demographics
NPI:1942432950
Name:CLUNY, RICHARD TRENT (OD)
Entity Type:Individual
Prefix:DR
First Name:RICHARD
Middle Name:TRENT
Last Name:CLUNY
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 1:547 CHEYENNE DR
Mailing Address - Street 2:
Mailing Address - City:EVANSTON
Mailing Address - State:WY
Mailing Address - Zip Code:82930-5302
Mailing Address - Country:US
Mailing Address - Phone:307-789-3937
Mailing Address - Fax:307-789-0797
Practice Address - Street 1:547 CHEYENNE DR
Practice Address - Street 2:
Practice Address - City:EVANSTON
Practice Address - State:WY
Practice Address - Zip Code:82930-5302
Practice Address - Country:US
Practice Address - Phone:307-789-3937
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-08-10
Last Update Date:2022-02-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR3335ATI152W00000X
WY446T152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist