Provider Demographics
NPI:1508533969
Name:406 ROLLIN' EYES
Entity Type:Organization
Organization Name:406 ROLLIN' EYES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/ABO CERTIFIED OPTICIAN
Authorized Official - Prefix:MRS
Authorized Official - First Name:SALICIA
Authorized Official - Middle Name:
Authorized Official - Last Name:BORGES
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:406-797-2020
Mailing Address - Street 1:928 BROADWATER AVE STE 103
Mailing Address - Street 2:
Mailing Address - City:BILLINGS
Mailing Address - State:MT
Mailing Address - Zip Code:59101-2700
Mailing Address - Country:US
Mailing Address - Phone:406-797-2020
Mailing Address - Fax:406-797-7227
Practice Address - Street 1:928 BROADWATER AVE STE 103
Practice Address - Street 2:
Practice Address - City:BILLINGS
Practice Address - State:MT
Practice Address - Zip Code:59101-2700
Practice Address - Country:US
Practice Address - Phone:406-797-2020
Practice Address - Fax:406-797-7227
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-08-24
Last Update Date:2022-05-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332H00000XSuppliersEyewear Supplier