Provider Demographics
NPI:1366654840
Name:BIG SKY OPTICAL
Entity Type:Organization
Organization Name:BIG SKY OPTICAL
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OPTICIAN
Authorized Official - Prefix:MR
Authorized Official - First Name:VERNON
Authorized Official - Middle Name:PAUL
Authorized Official - Last Name:KINGSTON
Authorized Official - Suffix:I
Authorized Official - Credentials:
Authorized Official - Phone:406-723-5223
Mailing Address - Street 1:14 SOUTH MONTANA
Mailing Address - Street 2:
Mailing Address - City:BUTTE
Mailing Address - State:MT
Mailing Address - Zip Code:59701-0000
Mailing Address - Country:US
Mailing Address - Phone:406-723-5223
Mailing Address - Fax:406-723-4542
Practice Address - Street 1:14 SOUTH MONTANA
Practice Address - Street 2:
Practice Address - City:BUTTE
Practice Address - State:MT
Practice Address - Zip Code:59701-0000
Practice Address - Country:US
Practice Address - Phone:406-723-5223
Practice Address - Fax:406-723-4542
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-04
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332H00000XSuppliersEyewear Supplier
Provider Identifiers
StateIdentifier IDID TypeIssuer
MT0555854Medicaid
MT0653660001Medicare ID - Type Unspecified