Provider Demographics
NPI:1679585996
Name:HELENA EYE CLINIC PC
Entity Type:Organization
Organization Name:HELENA EYE CLINIC PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:CRAIG
Authorized Official - Middle Name:L
Authorized Official - Last Name:WILKERSON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:406-443-4040
Mailing Address - Street 1:301 SADDLE DRIVE
Mailing Address - Street 2:
Mailing Address - City:HELENA
Mailing Address - State:MT
Mailing Address - Zip Code:59601-8098
Mailing Address - Country:US
Mailing Address - Phone:406-443-4040
Mailing Address - Fax:406-443-0773
Practice Address - Street 1:301 SADDLE DRIVE
Practice Address - Street 2:
Practice Address - City:HELENA
Practice Address - State:MT
Practice Address - Zip Code:59601-8098
Practice Address - Country:US
Practice Address - Phone:406-443-4040
Practice Address - Fax:406-443-0773
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-13
Last Update Date:2008-05-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MT10699207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MT0090559Medicaid
MT0090559Medicaid
MT5342840001Medicare NSC
H47273Medicare UPIN