Provider Demographics
NPI:1801921713
Name:ERPENBACH, LARRY D (OD)
Entity type:Individual
Prefix:DR
First Name:LARRY
Middle Name:D
Last Name:ERPENBACH
Suffix:
Gender:M
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2475 VILLAGE LN
Mailing Address - Street 2:SUITE 202
Mailing Address - City:BILLINGS
Mailing Address - State:MT
Mailing Address - Zip Code:59102-2497
Mailing Address - Country:US
Mailing Address - Phone:406-252-6608
Mailing Address - Fax:406-252-6600
Practice Address - Street 1:2475 VILLAGE LN
Practice Address - Street 2:SUITE 202
Practice Address - City:BILLINGS
Practice Address - State:MT
Practice Address - Zip Code:59102-2497
Practice Address - Country:US
Practice Address - Phone:406-252-6608
Practice Address - Fax:406-252-6600
Is Sole Proprietor?:No
Enumeration Date:2007-02-22
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MT1460261152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MT1460261OtherMT STATE ID
MT0482528Medicaid
MT499OtherMT MEDICAL LICENSE
MT27741OtherBCBS PROVIDER NUMBER
15008808OtherWORKERS COMP
MT3321OtherBLUE CHIP
MTCJ9407OtherRAILROAD MEDICARE
MTCJ9407OtherRAILROAD MEDICARE
MTCJ9407OtherRAILROAD MEDICARE
MT27741OtherBCBS PROVIDER NUMBER
MT000025083Medicare ID - Type UnspecifiedMT MEDICARE