Provider Demographics
NPI:1659433829
Name:JAMES E THREATT
Entity Type:Organization
Organization Name:JAMES E THREATT
Other - Org Name:DOC'S EYEGLASS SHOP
Other - Org Type:Other Name
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:JAMES
Authorized Official - Middle Name:E
Authorized Official - Last Name:THREATT
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:406-259-1280
Mailing Address - Street 1:907 BROADWATER SQ
Mailing Address - Street 2:
Mailing Address - City:BILLINGS
Mailing Address - State:MT
Mailing Address - Zip Code:59101-1634
Mailing Address - Country:US
Mailing Address - Phone:406-259-1155
Mailing Address - Fax:
Practice Address - Street 1:907 BROADWATER SQ
Practice Address - Street 2:
Practice Address - City:BILLINGS
Practice Address - State:MT
Practice Address - Zip Code:59101-1634
Practice Address - Country:US
Practice Address - Phone:406-259-1155
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-14
Last Update Date:2010-02-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MT4496332B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
MT0550596Medicaid
MT296090OtherBLUE CROSS BLUE SHIELD
MT0550596Medicaid