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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