Provider Demographics
NPI:1376705491
Name:PAYNE, RUTH ANN
Entity Type:Individual
Prefix:
First Name:RUTH
Middle Name:ANN
Last Name:PAYNE
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:601 W SPRUCE ST
Mailing Address - Street 2:SUITE E
Mailing Address - City:MISSOULA
Mailing Address - State:MT
Mailing Address - Zip Code:59802-4047
Mailing Address - Country:US
Mailing Address - Phone:406-728-0044
Mailing Address - Fax:406-728-0494
Practice Address - Street 1:601 W SPRUCE ST
Practice Address - Street 2:SUITE E
Practice Address - City:MISSOULA
Practice Address - State:MT
Practice Address - Zip Code:59802-4047
Practice Address - Country:US
Practice Address - Phone:406-728-0044
Practice Address - Fax:406-728-0494
Is Sole Proprietor?:No
Enumeration Date:2008-06-30
Last Update Date:2009-01-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes156FX1800XEye and Vision Services ProvidersTechnician/TechnologistOptician
Provider Identifiers
StateIdentifier IDID TypeIssuer
MT0550409Medicaid