Provider Demographics
NPI:1659555985
Name:LEONARD & DAVID VAINIO PC
Entity Type:Organization
Organization Name:LEONARD & DAVID VAINIO PC
Other - Org Name:AMERICAN EYECARE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OPTOMETRIST
Authorized Official - Prefix:DR
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:G
Authorized Official - Last Name:VAINIO
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:406-563-6471
Mailing Address - Street 1:100 W PARK AVE
Mailing Address - Street 2:
Mailing Address - City:ANACONDA
Mailing Address - State:MT
Mailing Address - Zip Code:59711-2259
Mailing Address - Country:US
Mailing Address - Phone:406-563-6471
Mailing Address - Fax:406-563-7252
Practice Address - Street 1:1313 HARRISON AVE
Practice Address - Street 2:
Practice Address - City:BUTTE
Practice Address - State:MT
Practice Address - Zip Code:59701-2112
Practice Address - Country:US
Practice Address - Phone:406-782-2359
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-12-21
Last Update Date:2008-04-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MTMT0426152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MT0617580013Medicare NSC