Provider Demographics
NPI:1174654206
Name:MARK F. OZOG M.D. P.C.
Entity Type:Organization
Organization Name:MARK F. OZOG M.D. P.C.
Other - Org Name:OZOG EYE CARE AND LASER CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:MRS
Authorized Official - First Name:AMANDA
Authorized Official - Middle Name:
Authorized Official - Last Name:HUHTALA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:406-453-1613
Mailing Address - Street 1:1417 9TH ST S STE 100
Mailing Address - Street 2:
Mailing Address - City:GREAT FALLS
Mailing Address - State:MT
Mailing Address - Zip Code:59405-4509
Mailing Address - Country:US
Mailing Address - Phone:406-453-1613
Mailing Address - Fax:406-453-3717
Practice Address - Street 1:1417 9TH ST S STE 100
Practice Address - Street 2:
Practice Address - City:GREAT FALLS
Practice Address - State:MT
Practice Address - Zip Code:59405-4509
Practice Address - Country:US
Practice Address - Phone:406-453-1613
Practice Address - Fax:406-453-3717
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-08
Last Update Date:2023-01-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MT7816332B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
MT4272070001Medicare NSC