Provider Demographics
NPI:1487816302
Name:RAVALLI FAMILY EYE CARE PC
Entity Type:Organization
Organization Name:RAVALLI FAMILY EYE CARE PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:D
Authorized Official - Last Name:HUTCHISON
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:406-363-1530
Mailing Address - Street 1:109 N 4TH ST
Mailing Address - Street 2:SUITE 105
Mailing Address - City:HAMILTON
Mailing Address - State:MT
Mailing Address - Zip Code:59840-2402
Mailing Address - Country:US
Mailing Address - Phone:406-363-1530
Mailing Address - Fax:406-363-1547
Practice Address - Street 1:109 N 4TH ST
Practice Address - Street 2:SUITE 105
Practice Address - City:HAMILTON
Practice Address - State:MT
Practice Address - Zip Code:59840-2402
Practice Address - Country:US
Practice Address - Phone:406-363-1530
Practice Address - Fax:406-363-1547
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-07-01
Last Update Date:2010-08-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MT599OPT332H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332H00000XSuppliersEyewear Supplier
Provider Identifiers
StateIdentifier IDID TypeIssuer
MT0480760Medicaid
MT00002685 1OtherBCBS
MT3866340001Medicare NSC
MTU51653Medicare UPIN
MT0480760Medicaid