Provider Demographics
NPI:1629020722
Name:MONTANA EYECARE LLP
Entity Type:Organization
Organization Name:MONTANA EYECARE LLP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OPTOMETRIST
Authorized Official - Prefix:
Authorized Official - First Name:WILLIAM
Authorized Official - Middle Name:H
Authorized Official - Last Name:SIMONS
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:406-443-2121
Mailing Address - Street 1:550 N MONTANA AVE
Mailing Address - Street 2:
Mailing Address - City:HELENA
Mailing Address - State:MT
Mailing Address - Zip Code:59601-3815
Mailing Address - Country:US
Mailing Address - Phone:406-443-2121
Mailing Address - Fax:406-443-4163
Practice Address - Street 1:550 N MONTANA AVE
Practice Address - Street 2:
Practice Address - City:HELENA
Practice Address - State:MT
Practice Address - Zip Code:59601-3815
Practice Address - Country:US
Practice Address - Phone:406-443-2121
Practice Address - Fax:406-443-4163
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-17
Last Update Date:2011-01-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MT1307180001OtherDMERC
MTCG4707OtherRAILROAD MEDICARE
MTCG4707OtherRAILROAD MEDICARE