NPIMap

Organization Active NPI

Cheyenne Vision Clinic P.C.

  • Optometrist
  • Cheyenne, WY
National Provider Identifier
1942365119
Registry record updated May 8, 2009
On this page

Key facts

NPPES NPI Registry
Primary specialty
OptometristTaxonomy code 152W00000X
License
149T Issued in WY
Legal business name
CHEYENNE VISION CLINIC P.C.
Practice address
1200 E Pershing Blvd
Cheyenne, WY 82001-3230
Phone
(307) 638-6610
Fax
(307) 638-6451
NPI assigned
Dec 27, 2006
Last updated
May 8, 2009By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on May 8, 2009

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

Authorized official

Name
Dr. Martin Carroll, ODNPI 1720073471
Title
Optometrist
Phone
(307) 638-6610

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Optometrist 152W00000X 149T WY Primary

Addresses

Primary practice location

1200 E Pershing Blvd
Cheyenne, WY 82001-3230

Mailing address

1200 E Pershing Blvd
Cheyenne, WY 82001-3230
Phone (307) 638-6610

Other identifiers 1

IdentifierTypeStateIssuer
106407000MedicaidWY

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in WY

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20040608001156 WY Part B Supplier - Clinic/Group Practice 8820071251 Receives reassigned benefits from 9 practitioners
1 other NPI on this enrollment
Practice locations: Cheyenne, WY; Laramie, WY

Other NPIs on the same Medicare enrollment 1

NPIs listed together on one Medicare enrollment, typically parts of the same organization.

National Provider Directory

National Provider Directory

Locations

408 S 2nd St
Laramie, WY 82070
Phone (307) 721-3937

Practitioners & affiliated clinicians

Practitioners 9

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.

NPI Registry JSON

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

{
    "created_epoch": "1167177600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1241740800000",
    "number": "1942365119",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1200 E PERSHING BLVD",
            "city": "CHEYENNE",
            "state": "WY",
            "postal_code": "820013230",
            "telephone_number": "307-638-6610",
            "fax_number": "307-638-6451"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1200 E PERSHING BLVD",
            "city": "CHEYENNE",
            "state": "WY",
            "postal_code": "820013230",
            "telephone_number": "307-638-6610",
            "fax_number": "307-638-6451"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "CHEYENNE VISION CLINIC P.C.",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-12-27",
        "last_updated": "2009-05-08",
        "status": "A",
        "authorized_official_last_name": "CARROLL",
        "authorized_official_first_name": "MARTIN",
        "authorized_official_title_or_position": "OPTOMETRIST",
        "authorized_official_telephone_number": "307-638-6610",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "OD"
    },
    "taxonomies": [
        {
            "code": "152W00000X",
            "taxonomy_group": "",
            "desc": "Optometrist",
            "state": "WY",
            "license": "149T",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "106407000",
            "state": "WY"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Cheyenne, WY

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 8, 2009; 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.