Provider Demographics
NPI:1760739882
Name:BILLINGS FAMILY OPTICAL PLLC
Entity Type:Organization
Organization Name:BILLINGS FAMILY OPTICAL PLLC
Other - Org Name:BILLINGS FAMILY EYECARE
Other - Org Type:Other Name
Authorized Official - Title/Position:OPTOMETRIST
Authorized Official - Prefix:DR
Authorized Official - First Name:DEVIN
Authorized Official - Middle Name:BURTON
Authorized Official - Last Name:DESPAIN
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:406-245-2299
Mailing Address - Street 1:1540 LAKE ELMO DR
Mailing Address - Street 2:SUITE 1
Mailing Address - City:BILLINGS
Mailing Address - State:MT
Mailing Address - Zip Code:59105-1797
Mailing Address - Country:US
Mailing Address - Phone:406-245-2299
Mailing Address - Fax:
Practice Address - Street 1:1540 LAKE ELMO DR
Practice Address - Street 2:SUITE 1
Practice Address - City:BILLINGS
Practice Address - State:MT
Practice Address - Zip Code:59105-1797
Practice Address - Country:US
Practice Address - Phone:406-245-2299
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-08-08
Last Update Date:2023-08-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MT800261Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center
Provider Identifiers
StateIdentifier IDID TypeIssuer
MT11002522Medicare PIN