Provider Demographics
NPI:1780695387
Name:ROCKY MOUNTAIN OPTICAL & CONTACT LENS CENTER, INC.
Entity type:Organization
Organization Name:ROCKY MOUNTAIN OPTICAL & CONTACT LENS CENTER, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:BILLING MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:KIM
Authorized Official - Middle Name:
Authorized Official - Last Name:BROE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:406-541-3806
Mailing Address - Street 1:PO BOX 4907
Mailing Address - Street 2:
Mailing Address - City:MISSOULA
Mailing Address - State:MT
Mailing Address - Zip Code:59806
Mailing Address - Country:US
Mailing Address - Phone:406-541-3937
Mailing Address - Fax:406-541-3811
Practice Address - Street 1:700 WEST KENT
Practice Address - Street 2:
Practice Address - City:MISSOULA
Practice Address - State:MT
Practice Address - Zip Code:59801
Practice Address - Country:US
Practice Address - Phone:406-541-3918
Practice Address - Fax:406-541-3813
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-10
Last Update Date:2024-02-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes156FX1800XEye and Vision Services ProvidersTechnician/TechnologistOpticianGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MT3958870001Medicare ID - Type Unspecified