Provider Demographics
NPI:1801299912
Name:EYES ON FREMONT LLC
Entity type:Organization
Organization Name:EYES ON FREMONT LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER/OPTOMETRIST
Authorized Official - Prefix:DR
Authorized Official - First Name:SHELLY
Authorized Official - Middle Name:
Authorized Official - Last Name:CADMAN
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:307-856-9000
Mailing Address - Street 1:704 E FREMONT AVE
Mailing Address - Street 2:
Mailing Address - City:RIVERTON
Mailing Address - State:WY
Mailing Address - Zip Code:82501-4421
Mailing Address - Country:US
Mailing Address - Phone:307-856-9000
Mailing Address - Fax:307-856-9004
Practice Address - Street 1:704 E FREMONT AVE
Practice Address - Street 2:
Practice Address - City:RIVERTON
Practice Address - State:WY
Practice Address - Zip Code:82501-4421
Practice Address - Country:US
Practice Address - Phone:307-856-9000
Practice Address - Fax:307-856-9004
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-10-02
Last Update Date:2014-11-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WY227T152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty