Organization Name: | LOWER VALLEY VISION CLINIC INC |
NPI Number: | 1336212158 |
Entity Type Code: | Organizational (2) |
Authorized Official Name: | LUKE BROG (PRESIDENT) |
Mailing Address: | 491 N Main St Suite A Thayne |
State: | WY US |
Postal Code: | 831279768 |
Phone Number: | 3078834678 |
Fax Number: | |
NPI Enumeration Date: | 11/17/2006 |
NPI Last Update Date: | 03/25/2013 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 332H00000X |
License Number: | 296T |
Healthcare Provider Taxonomy: (Secondary) | N |
State: | WY |
Taxonomy Type: | Suppliers |
Taxonomy Classification: | Eyewear Supplier (Equipment, not the service) |
Taxonomy Specialization: | |
Taxonomy Definition: | An organization that provides spectacles, contact lenses, and other vision enhancement devices prescribed by an optometrist or ophthalmologist. |