Brog, Luke Dewey

Brog, Luke Dewey is an individual health care provider with primary practice located at 122 Petersen Parkway Suite 1, Thayne WY 83127. He recently has only one registered license in Eye and Vision Services Providers / Optometrist, which is considered as his primary health care specialty. Brog, Luke Dewey can be contacted via phone (307) 883-4678.

Contact Information

Primary practice address
122 Petersen Parkway Suite 1 Thayne WY 83127
Phone: (307) 883-4678
Fax:
Website:
Map and Directions

Health care specialties

SpecialtyCodeLicense #State
Eye and Vision Services Providers / Optometrist 152W00000X 296T Wyoming

Profile Details

NPI number 1831262641
LBN Legal business name Brog, Luke Dewey
Credentials Doctor of Optometry (OD)
Entity Individual
Sole proprietor 1 No
Enumeration date Nov 17th, 2006
Last updated Jul 9th, 2007 - about 19 years ago

1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.

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Identifiers

StateTypeNumberIssuer
All States NPI 1831262641 NPPES
Wyoming Other 313773 BLUE CROSS BLUE SHIELD
Wyoming Other 285174 BLUE CROSS BLUE SHIELD
Wyoming Other 5646844 BLUE CROSS BLUE SHIELD

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