Provider Demographics
NPI:1952884355
Name:KALISPELL OPTOMETRY PLLC
Entity Type:Organization
Organization Name:KALISPELL OPTOMETRY PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:MALGORZATA
Authorized Official - Middle Name:
Authorized Official - Last Name:PODRAZA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:406-257-6803
Mailing Address - Street 1:170 HUTTON RANCH RD
Mailing Address - Street 2:
Mailing Address - City:KALISPELL
Mailing Address - State:MT
Mailing Address - Zip Code:59901-2107
Mailing Address - Country:US
Mailing Address - Phone:406-257-6803
Mailing Address - Fax:
Practice Address - Street 1:170 HUTTON RANCH RD
Practice Address - Street 2:
Practice Address - City:KALISPELL
Practice Address - State:MT
Practice Address - Zip Code:59901-2107
Practice Address - Country:US
Practice Address - Phone:406-257-6803
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-09-11
Last Update Date:2018-09-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NONEOtherNONE