Provider Demographics
NPI:1912566738
Name:EYE MAX OPHTHALMOLOGY & VISION SURGERY
Entity Type:Organization
Organization Name:EYE MAX OPHTHALMOLOGY & VISION SURGERY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/ PROVIDER
Authorized Official - Prefix:
Authorized Official - First Name:MAXIMILIAN
Authorized Official - Middle Name:
Authorized Official - Last Name:PSOLKA
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:254-458-5934
Mailing Address - Street 1:102 POINTER ST
Mailing Address - Street 2:
Mailing Address - City:NOLANVILLE
Mailing Address - State:TX
Mailing Address - Zip Code:76559-4713
Mailing Address - Country:US
Mailing Address - Phone:254-458-5934
Mailing Address - Fax:406-782-3802
Practice Address - Street 1:401 S ALABAMA ST STE 5
Practice Address - Street 2:
Practice Address - City:BUTTE
Practice Address - State:MT
Practice Address - Zip Code:59701-2358
Practice Address - Country:US
Practice Address - Phone:406-782-3808
Practice Address - Fax:406-782-3802
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-06-06
Last Update Date:2019-06-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmologyGroup - Multi-Specialty