Lower Valley Vision Clinic Inc

Primary specialty

OptometristTaxonomy code 152W00000X

License

296T Issued in WY

Legal business name

LOWER VALLEY VISION CLINIC INC

Practice address

491 N Main St
Suite a
Thayne, WY 83127-9768

Phone

(307) 883-4678

NPI assigned

Nov 17, 2006

Last updated

Mar 25, 2013By the provider in NPPES

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Dr. Luke Brog, O.D.NPI 1831262641

Title

President

Phone

(307) 883-4678

Specialties & licenses 2

Addresses

Other identifiers 4

Medicare fee-for-service enrollment

Enrolled in WY

Enrollment records 1

Locations

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

• Luke Dewey Brog, O.D.

  • Optometrist
  • Thayne, WY
  • NPI 1831262641
  Medicare reassignment NPD Authorized official

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1163721600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1364169600000",
    "number": "1336212158",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 800",
            "city": "THAYNE",
            "state": "WY",
            "postal_code": "831270800",
            "telephone_number": "307-883-4678"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "491 N MAIN ST",
            "address_2": "SUITE A",
            "city": "THAYNE",
            "state": "WY",
            "postal_code": "831279768",
            "telephone_number": "307-883-4678"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "LOWER VALLEY VISION CLINIC INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-11-17",
        "last_updated": "2013-03-25",
        "status": "A",
        "authorized_official_last_name": "BROG",
        "authorized_official_first_name": "LUKE",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "307-883-4678",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "O.D."
    },
    "taxonomies": [
        {
            "code": "332H00000X",
            "taxonomy_group": "",
            "desc": "Eyewear Supplier",
            "state": "WY",
            "license": "296T",
            "primary": false
        },
        {
            "code": "152W00000X",
            "taxonomy_group": "",
            "desc": "Optometrist",
            "state": "WY",
            "license": "296T",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "ALTIUS HEALTH PLANS",
            "identifier": "285174",
            "state": "WY"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "CBSA",
            "identifier": "5646844",
            "state": "WY"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "121600700",
            "state": "WY"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BLUE CROSS BLUE SHIELD",
            "identifier": "313773",
            "state": "WY"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Donald J Kirk, M.D.
• Sean Elliott Knighton, APRN
• Jennifer Suzanne Knowlton, LPC, LAT
• Kyle C Lancaster
• Legacy Home Assisted Living
• Mark W Johnson, DMD, PC (Riverside Dental)
• Kenneth Gerald Melton, DC
• Haile M Merritt
• Sherry S Merritt
• Prater Mountain Health Clinic

• Optometrist in Thayne, WY
• Providers in Thayne, WY by specialty
• Optometrist in Wyoming

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 25, 2013; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.