Provider Demographics
NPI:1811967565
Name:CHRISTMAN, PHILLIP (PC)
Entity type:Individual
Prefix:DR
First Name:PHILLIP
Middle Name:
Last Name:CHRISTMAN
Suffix:
Gender:M
Credentials:PC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:523 9TH ST S
Mailing Address - Street 2:
Mailing Address - City:GREAT FALLS
Mailing Address - State:MT
Mailing Address - Zip Code:59405
Mailing Address - Country:US
Mailing Address - Phone:406-727-9160
Mailing Address - Fax:406-771-8102
Practice Address - Street 1:523 9TH ST S
Practice Address - Street 2:
Practice Address - City:GREAT FALLS
Practice Address - State:MT
Practice Address - Zip Code:59405
Practice Address - Country:US
Practice Address - Phone:406-727-9160
Practice Address - Fax:406-771-8102
Is Sole Proprietor?:Yes
Enumeration Date:2006-01-25
Last Update Date:2009-04-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MTMT416152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MT0480896Medicaid
MT28120OtherBCBS
MT2812Medicare ID - Type Unspecified
MT28120OtherBCBS
T89274Medicare UPIN