Provider Demographics
NPI:1407874373
Name:ANACONDA EYE CARE PLLC
Entity Type:Organization
Organization Name:ANACONDA EYE CARE PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DOCTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:THOMAS
Authorized Official - Middle Name:E
Authorized Official - Last Name:YOCHEM
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:406-563-5141
Mailing Address - Street 1:PO BOX 999
Mailing Address - Street 2:
Mailing Address - City:ANACONDA
Mailing Address - State:MT
Mailing Address - Zip Code:59711-0999
Mailing Address - Country:US
Mailing Address - Phone:406-563-5141
Mailing Address - Fax:
Practice Address - Street 1:112 W 3RD ST
Practice Address - Street 2:
Practice Address - City:ANACONDA
Practice Address - State:MT
Practice Address - Zip Code:59711-2205
Practice Address - Country:US
Practice Address - Phone:406-563-5141
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-18
Last Update Date:2008-11-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MT539152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MT482560Medicaid
MT5738790001Medicare NSC
MT482560Medicaid
MT2893Medicare ID - Type Unspecified