Provider Demographics
NPI:1285831370
Name:COLUMBIA FALLS EYECARE, PC
Entity Type:Organization
Organization Name:COLUMBIA FALLS EYECARE, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:TROY
Authorized Official - Middle Name:R
Authorized Official - Last Name:YPMA
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:406-892-4140
Mailing Address - Street 1:211 - 5TH STREET WEST
Mailing Address - Street 2:
Mailing Address - City:COLUMBIA FALLS
Mailing Address - State:MT
Mailing Address - Zip Code:59912
Mailing Address - Country:US
Mailing Address - Phone:406-892-4140
Mailing Address - Fax:406-892-4146
Practice Address - Street 1:211 5TH ST W
Practice Address - Street 2:
Practice Address - City:COLUMBIA FALLS
Practice Address - State:MT
Practice Address - Zip Code:59912-3607
Practice Address - Country:US
Practice Address - Phone:406-892-4140
Practice Address - Fax:406-892-4146
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-07-02
Last Update Date:2011-08-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MT768152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MT610936600OtherDOL PROVIDER NUMBER
MTDD4200Medicare PIN
MT000084807Medicare PIN
MT5465550001Medicare NSC