Provider Demographics
NPI:1164414744
Name:CAYWOOD, TRAER GARY (OD)
Entity type:Individual
Prefix:DR
First Name:TRAER
Middle Name:GARY
Last Name:CAYWOOD
Suffix:
Gender:M
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:555 E BROADWAY AVE STE 214
Mailing Address - Street 2:
Mailing Address - City:JACKSON
Mailing Address - State:WY
Mailing Address - Zip Code:83001-8640
Mailing Address - Country:US
Mailing Address - Phone:307-733-1051
Mailing Address - Fax:307-733-0686
Practice Address - Street 1:555 E BROADWAY AVE STE 214
Practice Address - Street 2:
Practice Address - City:JACKSON
Practice Address - State:WY
Practice Address - Zip Code:83001-8640
Practice Address - Country:US
Practice Address - Phone:307-733-1051
Practice Address - Fax:307-733-0686
Is Sole Proprietor?:No
Enumeration Date:2005-08-18
Last Update Date:2025-09-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT91-111585-9934152W00000X, 152WC0802X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
No152WC0802XEye and Vision Services ProvidersOptometristCorneal and Contact Management
Provider Identifiers
StateIdentifier IDID TypeIssuer
UT529867420Medicaid
WY156816700Medicaid