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Organization

LOWER VALLEY VISION CLINIC INC

Active
Organization subpart
No

Provider details

NPI number
Authorized official
DR. LUKE BROG O.D. (PRESIDENT)
(307) 883-4678
Entity
Organization

Contact information

Practice address
491 N MAIN ST, SUITE A, THAYNE, WY 83127-9768
(307) 883-4678
Mailing address
PO BOX 800, THAYNE, WY 83127-0800
(307) 883-4678

Taxonomy

Speciality
Code
Description
License number
State
152W00000X
Optometrist
Primary
296T
WY
332H00000X
Eyewear Supplier
296T
WY

Other

Other identifiers
Code
Description
Identifier
Issuer
State
05
121600700
WY
01
285174
ALTIUS HEALTH PLANS
WY
01
313773
BLUE CROSS BLUE SHIELD
WY
01
5646844
CBSA
WY
Enumeration date
11/17/2006
Last updated
03/25/2013
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