Provider Demographics
NPI:1508934142
Name:LINDE, BRIAN E (OD)
Entity Type:Individual
Prefix:
First Name:BRIAN
Middle Name:E
Last Name:LINDE
Suffix:
Gender:M
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:430 LAKE ELMO DR
Mailing Address - Street 2:
Mailing Address - City:BILLINGS
Mailing Address - State:MT
Mailing Address - Zip Code:59105-3037
Mailing Address - Country:US
Mailing Address - Phone:406-252-9927
Mailing Address - Fax:406-252-6567
Practice Address - Street 1:430 LAKE ELMO DR
Practice Address - Street 2:
Practice Address - City:BILLINGS
Practice Address - State:MT
Practice Address - Zip Code:59105-3037
Practice Address - Country:US
Practice Address - Phone:406-252-9927
Practice Address - Fax:406-252-6567
Is Sole Proprietor?:No
Enumeration Date:2006-12-01
Last Update Date:2008-07-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MTMT532152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MT410035211OtherRAILROAD MEDICARE
MT482326Medicaid
MTT89289Medicare UPIN
MT0445350001Medicare NSC
MT482326Medicaid