Individual
DR. LUKE DEWEY BROG
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
O.D.
Contact information
Practice address
122 PETERSEN PARKWAY, SUITE 1, THAYNE, WY 83127
(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
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
285174
ALTIUS HEALTH PLANS
WY
01
—
313773
BLUE CROSS BLUE SHIELD
WY
01
—
5646844
CBSA
WY
Enumeration date
11/17/2006
Last updated
07/09/2007
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