Provider Demographics
NPI:1619730249
Name:ELECTRIC CITY EYES
Entity Type:Organization
Organization Name:ELECTRIC CITY EYES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OPTOMETRIST
Authorized Official - Prefix:DR
Authorized Official - First Name:AUDRA
Authorized Official - Middle Name:
Authorized Official - Last Name:SEXTON
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:605-484-9760
Mailing Address - Street 1:3604 2ND AVE S
Mailing Address - Street 2:
Mailing Address - City:GREAT FALLS
Mailing Address - State:MT
Mailing Address - Zip Code:59405-3559
Mailing Address - Country:US
Mailing Address - Phone:406-204-0074
Mailing Address - Fax:
Practice Address - Street 1:905 10TH AVE S
Practice Address - Street 2:
Practice Address - City:GREAT FALLS
Practice Address - State:MT
Practice Address - Zip Code:59405-4420
Practice Address - Country:US
Practice Address - Phone:406-204-0074
Practice Address - Fax:406-204-0075
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-02-05
Last Update Date:2024-02-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty