Provider Demographics
NPI:1306462098
Name:BISKUPIAK, ANGIE MARIE (OD)
Entity type:Individual
Prefix:
First Name:ANGIE
Middle Name:MARIE
Last Name:BISKUPIAK
Suffix:
Gender:F
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2120 GRAND AVE
Mailing Address - Street 2:
Mailing Address - City:BILLINGS
Mailing Address - State:MT
Mailing Address - Zip Code:59102-2603
Mailing Address - Country:US
Mailing Address - Phone:406-656-7605
Mailing Address - Fax:406-656-6430
Practice Address - Street 1:2120 GRAND AVE
Practice Address - Street 2:
Practice Address - City:BILLINGS
Practice Address - State:MT
Practice Address - Zip Code:59102-2603
Practice Address - Country:US
Practice Address - Phone:406-656-7605
Practice Address - Fax:406-656-6430
Is Sole Proprietor?:No
Enumeration Date:2020-06-18
Last Update Date:2024-03-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MTOPT-OPT-LIC-3896152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MT1437354834OtherGROUP NPI