Provider Demographics
NPI:1871648899
Name:SHULL, WILLIAM E (OD)
Entity Type:Individual
Prefix:DR
First Name:WILLIAM
Middle Name:E
Last Name:SHULL
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:BOX 747
Mailing Address - Street 2:100 W LYNCH ST
Mailing Address - City:PLAINS
Mailing Address - State:MT
Mailing Address - Zip Code:59859-0747
Mailing Address - Country:US
Mailing Address - Phone:406-826-3761
Mailing Address - Fax:406-826-3761
Practice Address - Street 1:100 W LYNCH ST
Practice Address - Street 2:
Practice Address - City:PLAINS
Practice Address - State:MT
Practice Address - Zip Code:59859-0747
Practice Address - Country:US
Practice Address - Phone:406-826-3761
Practice Address - Fax:406-826-3761
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-23
Last Update Date:2015-03-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MT322152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MT0489749Medicaid
0915080001OtherDME
T89238Medicare UPIN
MT26007Medicare ID - Type Unspecified