Provider Demographics
NPI:1235381401
Name:GREAT NORTHERN EYE CARE AND STUMPTOWN SPECTACLES, PLLC
Entity Type:Organization
Organization Name:GREAT NORTHERN EYE CARE AND STUMPTOWN SPECTACLES, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OPTOMETRIST/OWNER
Authorized Official - Prefix:
Authorized Official - First Name:EVA
Authorized Official - Middle Name:
Authorized Official - Last Name:BUKER
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:406-253-0086
Mailing Address - Street 1:6414 US HIGHWAY 93 S
Mailing Address - Street 2:
Mailing Address - City:WHITEFISH
Mailing Address - State:MT
Mailing Address - Zip Code:59937-8237
Mailing Address - Country:US
Mailing Address - Phone:406-862-6123
Mailing Address - Fax:
Practice Address - Street 1:6414 US HIGHWAY 93 S
Practice Address - Street 2:
Practice Address - City:WHITEFISH
Practice Address - State:MT
Practice Address - Zip Code:59937-8237
Practice Address - Country:US
Practice Address - Phone:406-862-6123
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-10-19
Last Update Date:2009-08-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MT639152W00000X
MT639 OPT261Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
No261Q00000XAmbulatory Health Care FacilitiesClinic/CenterGroup - Single Specialty