Provider Demographics
NPI:1851463947
Name:SORENSEN, STEVEN L (OD)
Entity Type:Individual
Prefix:DR
First Name:STEVEN
Middle Name:L
Last Name:SORENSEN
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 1:422 LOUISIANA AVE
Mailing Address - Street 2:
Mailing Address - City:LIBBY
Mailing Address - State:MT
Mailing Address - Zip Code:59923
Mailing Address - Country:US
Mailing Address - Phone:406-293-4136
Mailing Address - Fax:406-293-2033
Practice Address - Street 1:422 LOUISIANA AVE
Practice Address - Street 2:
Practice Address - City:LIBBY
Practice Address - State:MT
Practice Address - Zip Code:59923
Practice Address - Country:US
Practice Address - Phone:406-293-4136
Practice Address - Fax:406-293-2033
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-14
Last Update Date:2010-08-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MT495152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MT0483522Medicaid
MT0481468Medicaid
MT0481468Medicaid
MT000025089Medicare PIN
MT000025087Medicare PIN
MT410033211Medicare PIN
T95944Medicare UPIN