Organization
CHEYENNE VISION CLINIC P.C.
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. MARTIN CARROLL OD (OPTOMETRIST)
(307) 638-6610
Entity
Organization
Contact information
Practice address
1200 E PERSHING BLVD, CHEYENNE, WY 82001-3230
(307) 638-6610
(307) 638-6451
Mailing address
1200 E PERSHING BLVD, CHEYENNE, WY 82001-3230
(307) 638-6610
(307) 638-6451
Taxonomy
Speciality
Code
Description
License number
State
152W00000X
Optometrist
Primary
149T
WY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
106407000
—
WY
Enumeration date
12/27/2006
Last updated
05/08/2009
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