Organization
FAMILY VISION CENTER PC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. THERESA JO HAAS OD (PRESIDENT)
(307) 634-4232
Entity
Organization
Contact information
Practice address
400 E 18TH ST, CHEYENNE, WY 82001-4616
(307) 634-4232
(307) 778-8429
Mailing address
400 E 18TH ST, CHEYENNE, WY 82001-4616
(307) 634-4232
(307) 778-8429
Taxonomy
Speciality
Code
Description
License number
State
152W00000X
Optometrist
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
109909400
—
WY
01
—
CG2259
RR MEDICARE
WY
Enumeration date
12/07/2006
Last updated
03/10/2009
Update your record
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