Individual
MIKEL ROBERT WEIDEMAN
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
O.D.
Contact information
Practice address
556 MAIN ST, LANDER, WY 82520-3032
(307) 332-2020
Mailing address
556 MAIN ST, LANDER, WY 82520-3032
(307) 332-2020
Taxonomy
Speciality
Code
Description
License number
State
152W00000X
Optometrist
Primary
134T
WY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
106723100
—
WY
01
—
301173
BCBS
—
01
—
830260533
VISION SERVICE PLAN
—
Enumeration date
12/17/2006
Last updated
05/07/2020
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