Provider Demographics
NPI:1922206861
Name:DOLAN FAMILY VISION, INC.
Entity Type:Organization
Organization Name:DOLAN FAMILY VISION, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:DOUGLAS
Authorized Official - Middle Name:CRAIG
Authorized Official - Last Name:DOLAN
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:406-756-8420
Mailing Address - Street 1:20 VILLAGE LOOP RD
Mailing Address - Street 2:
Mailing Address - City:KALISPELL
Mailing Address - State:MT
Mailing Address - Zip Code:59901-2793
Mailing Address - Country:US
Mailing Address - Phone:406-756-8420
Mailing Address - Fax:406-756-0119
Practice Address - Street 1:20 VILLAGE LOOP RD
Practice Address - Street 2:
Practice Address - City:KALISPELL
Practice Address - State:MT
Practice Address - Zip Code:59901-2793
Practice Address - Country:US
Practice Address - Phone:406-756-8420
Practice Address - Fax:406-756-0119
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-07-03
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MTMT 518T152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MT048-3157Medicaid
MT055-1038Medicaid
MT055-1038Medicaid