Provider Type Icon

GILLETTE OPTOMETRIC CLINIC PC NPI 1891850707


NPI Information

NPI: 1891850707
Provider Name: GILLETTE OPTOMETRIC CLINIC PC
Classification: Optometrist - 152WC0802X
Entity Type: Organization

Specialization: Corneal and Contact Management

Address:
609 4J CT
GILLETTE, WY
ZIP 82716
Phone: (307) 682-2020
Get Directions

GILLETTE OPTOMETRIC CLINIC PC is a corneal and contact management optometrist in Gillette, WY. The provider is the professional activities performed by an Optometrist related to the fitting of contact lenses to an eye, ongoing evaluation of the cornea's ability to sustain successful contact lens wear, and treatment of any external eye or corneal condition which can affect contact lens wear. GILLETTE OPTOMETRIC CLINIC PC NPI is 1891850707. The provider is registered as an organization entity type and is a multiple single specialty group.

The provider's business location address is:

609 4J CT
GILLETTE, WY
ZIP 82716-135
Phone: (307) 682-2020
Fax: (307) 682-5656

The provider's authorized official is Roger L Jordan .
The authorized official title is President and has the following contact phone number (307) 682-2020.

The enumeration date for this NPI number is 12/22/2006 and was last updated on 4/13/2010.


Taxonomy Codes

The NPI record includes the healthcare provider taxonomy classification, state license number and state of licensure. The following information regarding the scope of practice of this provider is available:

No.Taxonomy CodeTaxonomy ClasificationTaxonomy SpecializationLicense NumberLicense StatePrimary
1152W00000XOptometrist93-TWYOMINGNo
2152WC0802XOptometristCorneal and Contact Management288-TWYOMINGNo
3152WV0400XOptometristVision Therapy263-TWYOMINGNo
4152WC0802XOptometristCorneal and Contact Management142-TWYOMINGYes

Other Identifiers

The following information regarding additional identifiers associated to this NPI record includes the other identifier number, identifier type, identifier state and issuer.

No.Other Provider IdentifierOther Provider Identifier TypeOther Provider Identifier StateOther Provider Identifier Issuer
1U11330MEDICARE UPINWYOMING
2103952100MEDICAIDWYOMING
31265466320OTHERWYOMINGJOSEPH MAYCOCK, OD
4103718800MEDICAIDWISCONSIN
511504720MEDICAIDWYOMING
65573070001MEDICARE NSCWYOMING
7W9902MEDICARE ID-TYPE UNSPECIFIEDWYOMINGJOSEPH MAYCOCK, OD
8W301430MEDICARE ID-TYPE UNSPECIFIEDWYOMINGROBERT MILLS, OD
91023035854OTHERWYOMINGDANA MCDERMOTT, OD
10U98131MEDICARE UPINWYOMING
11W310289MEDICARE ID-TYPE UNSPECIFIEDWYOMINGDANA MCDERMOTT, OD
1211903420MEDICAIDWYOMING
131972537561OTHERWYOMINGROGER JORDAN, OD
141659399376OTHERWYOMINGROBERT MILLS, OD
15U80357MEDICARE UPINWYOMING
16U10226MEDICARE UPINWYOMING
17W305124MEDICARE ID-TYPE UNSPECIFIEDWYOMINGROGER JORDAN, OD

What is NPI?

NPI stands for National Provider Identifier. The NPI is a 10-digit identification number that is completely unique. The NPI number by itself does not contain any identifiable information such as a provider’s speciality or location. The NPI is assigned to individuals or organizacions for their lifespan and it is independent of key provider information type updates like a change of practices, location or speciality.

This page was last updated on: 4/28/2024

All materials and services on this site are provided on an "as is" and "as available" basis without warranty of any kind. The NPI record is maintained by the National Plan & Provider Enumeration System (NPPES) and anyone may request this information and other NPPES health care provider data from HHS under The Freedom of Information Act (FOIA), Title 5 of the United States Code, section 552. To update the NPI records please contact the NPPES.