Provider Demographics
NPI:1780678938
Name:VAINIO, DAVID G (OD)
Entity Type:Individual
Prefix:DR
First Name:DAVID
Middle Name:G
Last Name:VAINIO
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 1:100 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 1:100 W PARK AVE
Practice Address - Street 2:
Practice Address - City:ANACONDA
Practice Address - State:MT
Practice Address - Zip Code:59711-2259
Practice Address - Country:US
Practice Address - Phone:406-563-6471
Practice Address - Fax:406-563-7252
Is Sole Proprietor?:Yes
Enumeration Date:2005-09-02
Last Update Date:2010-09-14
Deactivation Date:2006-03-24
Deactivation Code:
Reactivation Date:2006-03-29
Provider Licenses
StateLicense IDTaxonomies
MT426OPT152W00000X
MT0426152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MT1053342006OtherGROUP NPI
MTP00005738OtherRAILROAD MEDICARE
MT000482137Medicaid
MTD08606062OtherSUBMITTER ID
MT000082427Medicare ID - Type UnspecifiedSTATE OF MONTANA GROUP #
MT0617580013Medicare NSC
MT1053342006OtherGROUP NPI
MT0617580015Medicare NSC
MT0617580004Medicare NSC
MT0617580001Medicare NSC
MT000025098Medicare ID - Type UnspecifiedSTATE OF MONTANA MEDICARE
MT000082427Medicare PIN
MTP00005738OtherRAILROAD MEDICARE
MT0617580014Medicare NSC
MT0617580002Medicare NSC