Provider Demographics
NPI:1265747281
Name:VINCENT, JOSEPH WILLIAM (OD)
Entity type:Individual
Prefix:DR
First Name:JOSEPH
Middle Name:WILLIAM
Last Name:VINCENT
Suffix:
Gender:M
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:523 9TH ST S
Mailing Address - Street 2:
Mailing Address - City:GREAT FALLS
Mailing Address - State:MT
Mailing Address - Zip Code:59405-2113
Mailing Address - Country:US
Mailing Address - Phone:307-679-6832
Mailing Address - Fax:
Practice Address - Street 1:523 9TH ST S
Practice Address - Street 2:
Practice Address - City:GREAT FALLS
Practice Address - State:MT
Practice Address - Zip Code:59405-2113
Practice Address - Country:US
Practice Address - Phone:307-679-6832
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-08-13
Last Update Date:2011-08-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK2674152W00000X
MT825152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist