# GILLETTE OPTOMETRIC CLINIC PC

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1891850707
- **Authorized official:** DR. ROGER L JORDAN O.D. (PRESIDENT)
- **Authorized official phone:** (307) 682-2020

## Contact information

- **Practice address:** 609 4J CT, GILLETTE, WY 82716-4135
- **Practice address phone:** (307) 682-2020
- **Practice address fax:** (307) 682-5656
- **Mailing address:** 609 4J CT, GILLETTE, WY 82716-4135
- **Mailing address phone:** (307) 682-2020
- **Mailing address fax:** (307) 682-5656

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 152W00000X | Optometrist | 93-T | WY | — |
| 152WC0802X | Corneal and Contact Management Optometrist | 142-T | WY | Yes |
| 152WC0802X | Corneal and Contact Management Optometrist | 288-T | WY | — |
| 152WV0400X | Vision Therapy Optometrist | 263-T | WY | — |

## Other

- **Enumeration date:** 12/22/2006
- **Last updated:** 04/13/2010

## Other identifiers

| Code | Description | Identifier | Issuer | State |
| --- | --- | --- | --- | --- |
| 01 | — | 1023035854 | DANA MCDERMOTT, OD | WY |
| 05 | — | 103718800 | — | WI |
| 05 | — | 103952100 | — | WY |
| 05 | — | 11504720 | — | WY |
| 05 | — | 11903420 | — | WY |
| 01 | — | 1265466320 | JOSEPH MAYCOCK, OD | WY |
| 01 | — | 1659399376 | ROBERT MILLS, OD | WY |
| 01 | — | 1972537561 | ROGER JORDAN, OD | WY |