Wyoming Retina Associates, PC

Primary specialty

Ophthalmology PhysicianTaxonomy code 207W00000X

License

TL1625 Issued in WY

Legal business name

WYOMING RETINA ASSOCIATES, PC

Practice address

307 S Jackson St
Casper, WY 82601-2908

Phone

(307) 237-3937

Fax

(307) 237-0670

NPI assigned

Sep 19, 2011

Organization subpart

No

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

Authorized official

Name

Dr. Douglas Lyle Holmes, M.D.NPI 1073565487

Title

President

Phone

(307) 237-3937

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Enrolled in WY

Enrollment records 1

Practitioners 2

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

• Douglas L Holmes, M.D.

  • Retina Specialist (Ophthalmology) Physician
  • Casper, WY
  • NPI 1073565487
  Medicare reassignment NPD Authorized official
• Ram R Peddada, M.D., D.SC.

  • Ophthalmology Physician
  • Columbus, GA
  • NPI 1568471803
  NPD (past)

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

{
    "created_epoch": "1316390400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1316390400000",
    "number": "1467734202",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "307 S JACKSON ST",
            "city": "CASPER",
            "state": "WY",
            "postal_code": "826012908",
            "telephone_number": "307-237-3937",
            "fax_number": "307-237-0670"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "307 S JACKSON ST",
            "city": "CASPER",
            "state": "WY",
            "postal_code": "826012908",
            "telephone_number": "307-237-3937",
            "fax_number": "307-237-0670"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "WYOMING RETINA ASSOCIATES, PC",
        "organizational_subpart": "NO",
        "enumeration_date": "2011-09-19",
        "last_updated": "2011-09-19",
        "status": "A",
        "authorized_official_last_name": "HOLMES",
        "authorized_official_first_name": "DOUGLAS",
        "authorized_official_middle_name": "LYLE",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "307-237-3937",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "M.D."
    },
    "taxonomies": [
        {
            "code": "207W00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Ophthalmology",
            "state": "WY",
            "license": "TL1625",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• Wyoming Surgical Associates PC
• Wyoming Surgical Center LLC
• Wyoming Surgical Center MRI
• Wyoming Trauma Treatment Center

• Ophthalmology Physician in Casper, WY
• Providers in Casper, WY by specialty
• Ophthalmology Physician in Wyoming

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 19, 2011; 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.