Provider Demographics
NPI:1114090388
Name:BIGFORK EYE CLINIC P.C.
Entity Type:Organization
Organization Name:BIGFORK EYE CLINIC P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OPTICIAN OFFICE ASSISTANT
Authorized Official - Prefix:
Authorized Official - First Name:ERICA
Authorized Official - Middle Name:
Authorized Official - Last Name:ATLEE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:406-837-6883
Mailing Address - Street 1:8111 MT HIGHWAY 35 STE 6
Mailing Address - Street 2:
Mailing Address - City:BIGFORK
Mailing Address - State:MT
Mailing Address - Zip Code:59911-3589
Mailing Address - Country:US
Mailing Address - Phone:406-837-6883
Mailing Address - Fax:406-837-2063
Practice Address - Street 1:8111 MT HIGHWAY 35 STE 6
Practice Address - Street 2:
Practice Address - City:BIGFORK
Practice Address - State:MT
Practice Address - Zip Code:59911-3589
Practice Address - Country:US
Practice Address - Phone:406-837-6883
Practice Address - Fax:406-837-2063
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-16
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MT409152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
26470OtherBCBS
MT0484367Medicaid
MT0484367Medicaid