Provider Demographics
NPI:1912099433
Name:ARRANTS PEMBROKE PC
Entity Type:Organization
Organization Name:ARRANTS PEMBROKE PC
Other - Org Name:WYOMING VISION CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OPTOMETRIST SECRETARY
Authorized Official - Prefix:DR
Authorized Official - First Name:ALISON
Authorized Official - Middle Name:
Authorized Official - Last Name:ARRANTS
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:307-382-4444
Mailing Address - Street 1:PO BOX 2250
Mailing Address - Street 2:
Mailing Address - City:ROCK SPRINGS
Mailing Address - State:WY
Mailing Address - Zip Code:82902-2250
Mailing Address - Country:US
Mailing Address - Phone:307-382-4444
Mailing Address - Fax:
Practice Address - Street 1:2820 FOOTHILL BLVD
Practice Address - Street 2:
Practice Address - City:ROCK SPRINGS
Practice Address - State:WY
Practice Address - Zip Code:82901-4836
Practice Address - Country:US
Practice Address - Phone:307-382-4444
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-29
Last Update Date:2015-10-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
WY123145600Medicaid