Provider Demographics
NPI:1346459328
Name:BEYER BIG SKY OPTICAL, INC
Entity Type:Organization
Organization Name:BEYER BIG SKY OPTICAL, INC
Other - Org Name:BIG SKY EYE CARE CLINIC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OPTOMETRIST
Authorized Official - Prefix:DR
Authorized Official - First Name:DIRK
Authorized Official - Middle Name:MICHAEL
Authorized Official - Last Name:BEYER
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:406-363-2020
Mailing Address - Street 1:PO BOX 2068
Mailing Address - Street 2:
Mailing Address - City:HAMILTON
Mailing Address - State:MT
Mailing Address - Zip Code:59840-4068
Mailing Address - Country:US
Mailing Address - Phone:406-363-2020
Mailing Address - Fax:406-363-0646
Practice Address - Street 1:820 W MAIN ST
Practice Address - Street 2:
Practice Address - City:HAMILTON
Practice Address - State:MT
Practice Address - Zip Code:59840-2330
Practice Address - Country:US
Practice Address - Phone:406-363-2020
Practice Address - Fax:406-363-0646
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-22
Last Update Date:2007-12-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MT634152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MT0481321Medicaid
MT0481321Medicaid
MT000025038Medicare PIN
MT4452900001Medicare NSC