Provider Demographics
NPI:1740867506
Name:ECKERT, WYATT (OD)
Entity type:Individual
Prefix:DR
First Name:WYATT
Middle Name:
Last Name:ECKERT
Suffix:
Gender:M
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5370 TREASURE CANYON DR
Mailing Address - Street 2:
Mailing Address - City:HELENA
Mailing Address - State:MT
Mailing Address - Zip Code:59602-9059
Mailing Address - Country:US
Mailing Address - Phone:406-465-5474
Mailing Address - Fax:
Practice Address - Street 1:580 N MERIDIAN RD
Practice Address - Street 2:
Practice Address - City:KALISPELL
Practice Address - State:MT
Practice Address - Zip Code:59901
Practice Address - Country:US
Practice Address - Phone:406-755-5910
Practice Address - Fax:406-756-5701
Is Sole Proprietor?:Yes
Enumeration Date:2021-03-26
Last Update Date:2022-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
390200000X
MT4479152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program