Provider Demographics
NPI:1235118258
Name:STANCHFIELD, MARK (OD)
Entity Type:Individual
Prefix:DR
First Name:MARK
Middle Name:
Last Name:STANCHFIELD
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 1:226 9TH AVE SE
Mailing Address - Street 2:
Mailing Address - City:CUT BANK
Mailing Address - State:MT
Mailing Address - Zip Code:59427-3332
Mailing Address - Country:US
Mailing Address - Phone:406-873-5623
Mailing Address - Fax:406-873-5624
Practice Address - Street 1:226 9TH AVE SE
Practice Address - Street 2:
Practice Address - City:CUT BANK
Practice Address - State:MT
Practice Address - Zip Code:59427-3332
Practice Address - Country:US
Practice Address - Phone:406-873-5623
Practice Address - Fax:406-873-5624
Is Sole Proprietor?:Yes
Enumeration Date:2006-01-10
Last Update Date:2009-04-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MT516152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MT048-1377Medicaid
MT1235118258OtherNPI
MT0249250001OtherMEDICARE NSC
MT0249250001Medicare NSC
MTT89276Medicare UPIN
MT048-1377Medicaid