Provider Demographics
NPI:1801855044
Name:DR BROTT & ASSOCIATES OD PC
Entity Type:Organization
Organization Name:DR BROTT & ASSOCIATES OD PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER OPTOMETRIST
Authorized Official - Prefix:DR
Authorized Official - First Name:HEIDI
Authorized Official - Middle Name:G
Authorized Official - Last Name:BROTT
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:406-251-3679
Mailing Address - Street 1:4000 US HIGHWAY 93 S
Mailing Address - Street 2:
Mailing Address - City:MISSOULA
Mailing Address - State:MT
Mailing Address - Zip Code:59804-7347
Mailing Address - Country:US
Mailing Address - Phone:406-251-3679
Mailing Address - Fax:406-251-3715
Practice Address - Street 1:4000 US HIGHWAY 93 S
Practice Address - Street 2:
Practice Address - City:MISSOULA
Practice Address - State:MT
Practice Address - Zip Code:59804-7347
Practice Address - Country:US
Practice Address - Phone:406-251-3679
Practice Address - Fax:406-251-3715
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-03-17
Last Update Date:2008-06-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MT577152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MT0484120Medicaid
U47858Medicare UPIN
000025094Medicare ID - Type Unspecified