Organization
GILLETTE OPTOMETRIC CLINIC PC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. ROGER L JORDAN O.D. (PRESIDENT)
(307) 682-2020
Entity
Organization
Contact information
Practice address
609 4J CT, GILLETTE, WY 82716-4135
(307) 682-2020
(307) 682-5656
Mailing address
609 4J CT, GILLETTE, WY 82716-4135
(307) 682-2020
(307) 682-5656
Taxonomy
Speciality
Code
Description
License number
State
152W00000X
Optometrist
93-T
WY
152WC0802X
Corneal and Contact Management Optometrist
Primary
142-T
WY
152WC0802X
Corneal and Contact Management Optometrist
288-T
WY
152WV0400X
Vision Therapy Optometrist
263-T
WY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1023035854
DANA MCDERMOTT, OD
WY
05
—
103718800
—
WI
05
—
103952100
—
WY
05
—
11504720
—
WY
05
—
11903420
—
WY
01
—
1265466320
JOSEPH MAYCOCK, OD
WY
01
—
1659399376
ROBERT MILLS, OD
WY
01
—
1972537561
ROGER JORDAN, OD
WY
Enumeration date
12/22/2006
Last updated
04/13/2010
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