Provider Demographics
NPI:1669585519
Name:EAST MONTANA VISION CENTER
Entity type:Organization
Organization Name:EAST MONTANA VISION CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:MARK
Authorized Official - Middle Name:R
Authorized Official - Last Name:DILL
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:406-346-2020
Mailing Address - Street 1:PO BOX 5030
Mailing Address - Street 2:
Mailing Address - City:FORSYTH
Mailing Address - State:MT
Mailing Address - Zip Code:59327-5030
Mailing Address - Country:US
Mailing Address - Phone:406-346-2020
Mailing Address - Fax:
Practice Address - Street 1:192 N. 10TH STREET
Practice Address - Street 2:BOX 5030
Practice Address - City:FORSYTH
Practice Address - State:MT
Practice Address - Zip Code:59327
Practice Address - Country:US
Practice Address - Phone:406-346-2020
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-16
Last Update Date:2014-02-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MT735152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
U93310Medicare UPIN