Provider Demographics
NPI:1750349049
Name:HABER, AMANDA LEE (OD)
Entity type:Individual
Prefix:
First Name:AMANDA
Middle Name:LEE
Last Name:HABER
Suffix:
Gender:F
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:430 LAKE ELMO DR
Mailing Address - Street 2:
Mailing Address - City:BILLINGS
Mailing Address - State:MT
Mailing Address - Zip Code:59105-3066
Mailing Address - Country:US
Mailing Address - Phone:406-252-9927
Mailing Address - Fax:
Practice Address - Street 1:2290 KING AVE W
Practice Address - Street 2:COSTCO OPTOMETRIST
Practice Address - City:BILLINGS
Practice Address - State:MT
Practice Address - Zip Code:59102-7415
Practice Address - Country:US
Practice Address - Phone:971-221-5342
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-05-03
Last Update Date:2012-08-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MT767152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MTV06514Medicare UPIN