1629020722 NPI number — MONTANA EYECARE LLP

Table of content: (NPI 1629020722)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1629020722 NPI number — MONTANA EYECARE LLP

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
MONTANA EYECARE LLP
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1629020722
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
01/24/2011
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
550 N MONTANA AVE
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
HELENA
Provider Business Mailing Address State Name:
MT
Provider Business Mailing Address Postal Code:
59601-3815
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
406-443-2121
Provider Business Mailing Address Fax Number:
406-443-4163

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
550 N MONTANA AVE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
HELENA
Provider Business Practice Location Address State Name:
MT
Provider Business Practice Location Address Postal Code:
59601-3815
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
406-443-2121
Provider Business Practice Location Address Fax Number:
406-443-4163
Provider Enumeration Date:
05/17/2006

Additional Information

Authorized Official

Authorized Official Last Name:
SIMONS
Authorized Official First Name:
WILLIAM
Authorized Official Middle Name:
H
Authorized Official Title or Position:
OPTOMETRIST
Authorized Official Telephone Number:
406-443-2121

Provider Taxonomy Codes

  • Taxonomy code: 152W00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 1307180001 . This is a "DMERC" identifier , issued by the state of ( MT ) . This identifiers is of the category "OTHER".
  • Identifier: CG4707 . This is a "RAILROAD MEDICARE" identifier , issued by the state of ( MT ) . This identifiers is of the category "OTHER".




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