Provider Demographics
NPI:1245217199
Name:EYECARE ASSOCIATES OF LEWISTOWN PC
Entity Type:Organization
Organization Name:EYECARE ASSOCIATES OF LEWISTOWN PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:JASON
Authorized Official - Middle Name:A
Authorized Official - Last Name:RICKS
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:406-535-2020
Mailing Address - Street 1:PO BOX 59
Mailing Address - Street 2:
Mailing Address - City:LEWISTOWN
Mailing Address - State:MT
Mailing Address - Zip Code:59457-0059
Mailing Address - Country:US
Mailing Address - Phone:406-538-5488
Mailing Address - Fax:406-538-3210
Practice Address - Street 1:119 E MAIN ST
Practice Address - Street 2:
Practice Address - City:LEWISTOWN
Practice Address - State:MT
Practice Address - Zip Code:59457-1710
Practice Address - Country:US
Practice Address - Phone:406-538-5488
Practice Address - Fax:406-538-3210
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-12-30
Last Update Date:2023-03-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MT555152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MT0483650Medicaid
MTP00227881OtherRAIL ROAD MEDICARE
MT5836860001Medicare NSC
MTP00227881OtherRAIL ROAD MEDICARE