Provider Demographics
NPI:1568444735
Name:MONTGOMERY, ALAN K (OD)
Entity Type:Individual
Prefix:DR
First Name:ALAN
Middle Name:K
Last Name:MONTGOMERY
Suffix:
Gender:M
Credentials:OD
Other - Prefix:DR
Other - First Name:ALAN
Other - Middle Name:K
Other - Last Name:MONTGOMERY
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:PLC
Mailing Address - Street 1:55021 M 51 N
Mailing Address - Street 2:
Mailing Address - City:DOWAGIAC
Mailing Address - State:MI
Mailing Address - Zip Code:49047-9664
Mailing Address - Country:US
Mailing Address - Phone:269-782-3476
Mailing Address - Fax:269-782-6631
Practice Address - Street 1:55021 M 51 N
Practice Address - Street 2:
Practice Address - City:DOWAGIAC
Practice Address - State:MI
Practice Address - Zip Code:49047-9664
Practice Address - Country:US
Practice Address - Phone:269-782-3476
Practice Address - Fax:269-782-6631
Is Sole Proprietor?:Yes
Enumeration Date:2005-11-15
Last Update Date:2008-03-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4901002313152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI0A46504Medicare PIN
E20234Medicare UPIN