1760739882 NPI number — BILLINGS FAMILY OPTICAL PLLC

Table of content: (NPI 1760739882)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1760739882 NPI number — BILLINGS FAMILY OPTICAL PLLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
BILLINGS FAMILY OPTICAL PLLC
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:
6
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:
1760739882
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
08/29/2023
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1540 LAKE ELMO DR
Provider Second Line Business Mailing Address:
SUITE 1
Provider Business Mailing Address City Name:
BILLINGS
Provider Business Mailing Address State Name:
MT
Provider Business Mailing Address Postal Code:
59105-1797
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
406-245-2299
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1540 LAKE ELMO DR
Provider Second Line Business Practice Location Address:
SUITE 1
Provider Business Practice Location Address City Name:
BILLINGS
Provider Business Practice Location Address State Name:
MT
Provider Business Practice Location Address Postal Code:
59105-1797
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
406-245-2299
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
08/08/2012

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
DESPAIN
Authorized Official First Name:
DEVIN
Authorized Official Middle Name:
BURTON
Authorized Official Title or Position:
OPTOMETRIST
Authorized Official Telephone Number:
406-245-2299

Provider Taxonomy Codes

  • Taxonomy code: 261Q00000X , with the licence number:  800 , registered in the state of MT ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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