Provider Demographics
NPI:1043830722
Name:MOUNTAIN WEST EYE CARE P.C.
Entity type:Organization
Organization Name:MOUNTAIN WEST EYE CARE P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:AUTHORIZED OFFICIAL
Authorized Official - Prefix:
Authorized Official - First Name:EMILY
Authorized Official - Middle Name:
Authorized Official - Last Name:BRYANT
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:307-431-6398
Mailing Address - Street 1:607 BIG HORN AVE
Mailing Address - Street 2:
Mailing Address - City:WORLAND
Mailing Address - State:WY
Mailing Address - Zip Code:82401-2603
Mailing Address - Country:US
Mailing Address - Phone:307-752-2749
Mailing Address - Fax:
Practice Address - Street 1:607 BIG HORN AVE
Practice Address - Street 2:
Practice Address - City:WORLAND
Practice Address - State:WY
Practice Address - Zip Code:82401-2603
Practice Address - Country:US
Practice Address - Phone:307-431-6398
Practice Address - Fax:307-347-3990
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-04-22
Last Update Date:2024-07-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
WY155720300Medicaid
WY1043830722OtherGROUP