Provider Demographics
NPI:1255909511
Name:FELTON EYECARE, PLLC
Entity type:Organization
Organization Name:FELTON EYECARE, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:TY
Authorized Official - Middle Name:WILLIAM
Authorized Official - Last Name:FELTON
Authorized Official - Suffix:
Authorized Official - Credentials:OPTOMETRIST
Authorized Official - Phone:406-360-8280
Mailing Address - Street 1:2230 N RESERVE ST STE 330
Mailing Address - Street 2:
Mailing Address - City:MISSOULA
Mailing Address - State:MT
Mailing Address - Zip Code:59808-1364
Mailing Address - Country:US
Mailing Address - Phone:406-360-8280
Mailing Address - Fax:
Practice Address - Street 1:2230 N RESERVE ST STE 330
Practice Address - Street 2:
Practice Address - City:MISSOULA
Practice Address - State:MT
Practice Address - Zip Code:59808-1364
Practice Address - Country:US
Practice Address - Phone:406-360-8280
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-06-14
Last Update Date:2021-11-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MT1073028213Medicaid