Provider Demographics
NPI:1093880692
Name:DENNEHY, BRANDT (OD)
Entity Type:Individual
Prefix:DR
First Name:BRANDT
Middle Name:
Last Name:DENNEHY
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 1:2260 SOUTH DR
Mailing Address - Street 2:
Mailing Address - City:BUTTE
Mailing Address - State:MT
Mailing Address - Zip Code:59701-6168
Mailing Address - Country:US
Mailing Address - Phone:406-782-6212
Mailing Address - Fax:
Practice Address - Street 1:2410 AMHERST AVE
Practice Address - Street 2:
Practice Address - City:BUTTE
Practice Address - State:MT
Practice Address - Zip Code:59701-3800
Practice Address - Country:US
Practice Address - Phone:406-494-6692
Practice Address - Fax:406-494-2205
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-21
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MT670152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MT480709Medicaid
MT25016Medicare ID - Type Unspecified
MT480709Medicaid