| NPI | 1205271053 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | MICHAEL B. WARDELL Doctor/Owner 406-281-8480 |
| Organization Subpart ? | No |
| Primary Taxonomy | 152W00000X Optometrist (Licence: MT 528) |
| Additional Taxonomies | 302F00000X Exclusive Provider Organization (Licence: MT 528) |
| Enumeration Date | 2013-05-07 |
| Last Update Date | 2017-08-25 |