Provider Demographics
NPI:1780239525
Name:MONTAGUE VISION LLC
Entity type:Organization
Organization Name:MONTAGUE VISION LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:PAUL
Authorized Official - Middle Name:R
Authorized Official - Last Name:MONTAGUE
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:570-687-7943
Mailing Address - Street 1:PO BOX 310
Mailing Address - Street 2:
Mailing Address - City:CONYNGHAM
Mailing Address - State:PA
Mailing Address - Zip Code:18219-0310
Mailing Address - Country:US
Mailing Address - Phone:570-687-7943
Mailing Address - Fax:717-685-3250
Practice Address - Street 1:1129 QUENTIN RD
Practice Address - Street 2:
Practice Address - City:LEBANON
Practice Address - State:PA
Practice Address - Zip Code:17042-6915
Practice Address - Country:US
Practice Address - Phone:717-272-7059
Practice Address - Fax:717-272-2155
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-08-08
Last Update Date:2019-08-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty