Provider Demographics
NPI:1508042607
Name:WARD, STEWART R (OD)
Entity Type:Individual
Prefix:
First Name:STEWART
Middle Name:R
Last Name:WARD
Suffix:
Gender:M
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:PO BOX 4907
Mailing Address - Street 2:700 WEST KENT
Mailing Address - City:MISSOULA
Mailing Address - State:MT
Mailing Address - Zip Code:59801-7000
Mailing Address - Country:US
Mailing Address - Phone:406-541-3937
Mailing Address - Fax:406-541-3810
Practice Address - Street 1:700 WEST KENT
Practice Address - Street 2:
Practice Address - City:MISSOULA
Practice Address - State:MT
Practice Address - Zip Code:59801-7000
Practice Address - Country:US
Practice Address - Phone:406-541-3937
Practice Address - Fax:406-541-3810
Is Sole Proprietor?:No
Enumeration Date:2008-01-18
Last Update Date:2008-01-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MT313152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MT2843Medicare UPIN