Mud Springs Vision Clinic, Inc. – Optometrist

Key facts

NPI: 1043554686
Entity type: Organization (NPI type 2)
Primary specialty: Optometrist 152W00000X
License: 340T (WY)
Legal business name: MUD SPRINGS VISION CLINIC, INC.
Practice address: 404 9TH St
Wheatland, WY 82201-2910
Phone: (307) 322-9747
Fax: (307) 322-9776
NPI assigned: Nov 20, 2012
Organization subpart: No

Authorized official

Name: Jaime A Hazen, O.D. NPI 1164770988
Title: Owner
Phone: (307) 322-9747

Authorized official NPPES reports the authorized official by name only; the link goes to the one practitioner connected to this organization with that name.

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

Jaime Hazen, O.D. Optometrist · Wheatland, WY · NPI 1164770988

Medicare reassignment NPD Authorized official OPTOMETRIST · WY

Laboratory certificates & supplier records

Name & address match These CMS records do not include an NPI. They are shown here because their name and street address match this provider’s.

Medicare medical equipment & supply locations

Supplier	Supplies	Medicare assignment
Mud Springs Vision Clinic Inc 404 9TH Street, Wheatland, WY 82201-2910 · (307) 322-9747	Prosthetic Lenses: Conventional Eyeglasses\|Prosthetic Lenses: Conventional Contact Lenses	Accepts assignment Participating since Jan 7, 2013

Medicare participation

Medicare fee-for-service enrollment: Enrolled (2 enrollments) in WY

Medicare enrollment records

Enrollment ID	State	Provider type	PAC ID	Details
O20130417000634	WY	Part B Supplier - Clinic/Group Practice	4183860182	Receives reassigned benefits from 1 practitioner Practice locations: Wheatland, WY
O20130710000480	WY	DME Supplier - Physician - Optometrist	4183860182	Practice locations: Wheatland, WY

National Provider Directory

Specialties & licenses

Specialty (taxonomy)	Code	License	State	Primary
Optometrist Group: 193400000X SINGLE SPECIALTY GROUP	152W00000X	340T	WY	Yes

Addresses

Primary practice location

404 9TH St
Wheatland, WY 82201-2910

Mailing address

404 9TH St
Wheatland, WY 82201-2910
Phone (307) 322-9747

Other providers in Wheatland, WY

All providers in Wheatland, WY · Optometrist in Wyoming

Sources for this page

NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Nov 20, 2012. Information in NPPES is self-reported and not verified by CMS.
NUCC Health Care Provider Taxonomy: specialty names.
Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
Medicare Care Compare provider data (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.