Provider Demographics
NPI:1205280989
Name:GALLATIN VALLEY VISION, LLC
Entity type:Organization
Organization Name:GALLATIN VALLEY VISION, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OPTOMETRIST
Authorized Official - Prefix:DR
Authorized Official - First Name:JESSICA
Authorized Official - Middle Name:
Authorized Official - Last Name:LEMONS
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:406-581-5181
Mailing Address - Street 1:2825 W MAIN ST STE 1E
Mailing Address - Street 2:
Mailing Address - City:BOZEMAN
Mailing Address - State:MT
Mailing Address - Zip Code:59718-3927
Mailing Address - Country:US
Mailing Address - Phone:406-587-7050
Mailing Address - Fax:406-587-0525
Practice Address - Street 1:2825 W MAIN ST STE 1E
Practice Address - Street 2:
Practice Address - City:BOZEMAN
Practice Address - State:MT
Practice Address - Zip Code:59718-3927
Practice Address - Country:US
Practice Address - Phone:406-587-7050
Practice Address - Fax:406-587-0525
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-04-19
Last Update Date:2016-04-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MT2236152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty