Organization
LANDER VISION CENTER, PC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. MIKEL ROBERT WEIDEMAN O.D. (PRESIDENT)
(307) 332-2020
Entity
Organization
Contact information
Practice address
556 MAIN ST, LANDER, WY 82520-3032
(307) 332-2020
(307) 332-5718
Mailing address
556 MAIN ST, LANDER, WY 82520-3032
(307) 332-5718
Taxonomy
Speciality
Code
Description
License number
State
152W00000X
Optometrist
Primary
134T
WY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
106723100
—
WY
Enumeration date
02/27/2007
Last updated
12/10/2009
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