Provider Demographics
NPI:1205271053
Name:WARDELL VISION CENTER, PC
Entity type:Organization
Organization Name:WARDELL VISION CENTER, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DOCTOR/OWNER
Authorized Official - Prefix:
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:B
Authorized Official - Last Name:WARDELL
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:406-281-8480
Mailing Address - Street 1:1005 24TH ST W STE 8
Mailing Address - Street 2:
Mailing Address - City:BILLINGS
Mailing Address - State:MT
Mailing Address - Zip Code:59102-3800
Mailing Address - Country:US
Mailing Address - Phone:406-281-8480
Mailing Address - Fax:406-281-8481
Practice Address - Street 1:1005 24TH ST W STE 8
Practice Address - Street 2:
Practice Address - City:BILLINGS
Practice Address - State:MT
Practice Address - Zip Code:59102-3800
Practice Address - Country:US
Practice Address - Phone:406-281-8480
Practice Address - Fax:406-281-8481
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-05-07
Last Update Date:2017-08-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MT528302F00000X, 152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
No302F00000XManaged Care OrganizationsExclusive Provider OrganizationGroup - Single Specialty