Provider Demographics
NPI:1750638219
Name:SIDNEY EYE CARE PLLC
Entity Type:Organization
Organization Name:SIDNEY EYE CARE PLLC
Other - Org Name:DR KRISTIN OBRIEN
Other - Org Type:Other Name
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:KRISTIN
Authorized Official - Middle Name:
Authorized Official - Last Name:OBRIEN
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:406-482-2609
Mailing Address - Street 1:PO BOX 1008
Mailing Address - Street 2:
Mailing Address - City:SIDNEY
Mailing Address - State:MT
Mailing Address - Zip Code:59270-1008
Mailing Address - Country:US
Mailing Address - Phone:406-482-2609
Mailing Address - Fax:406-482-2697
Practice Address - Street 1:112 2ND ST SE
Practice Address - Street 2:
Practice Address - City:SIDNEY
Practice Address - State:MT
Practice Address - Zip Code:59270-4104
Practice Address - Country:US
Practice Address - Phone:406-482-2609
Practice Address - Fax:406-482-2697
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-08-14
Last Update Date:2013-09-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MT813152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MT1750638219Medicaid
MTMT26073OtherBCBS
MT4064822609OtherVSP
MTP00868264OtherRAILROAD MEDICARE
MT6802110001OtherMEDICARE DMEPOS
MT893290OtherNORTH DAKOTA VISION
MT1750638219Medicaid
MTM011002540Medicare PIN