| NPI | 1225209513 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | SONIA K BECKER Credentialing 406-577-2507 |
| Organization Subpart ? | Yes |
| Primary Taxonomy | 152W00000X Optometrist (Licence: MT 0492) |
| Additional Taxonomies | 332BC3200X Durable Medical Equipment & Medical Supplies, Customized Equipment |
| Enumeration Date | 2008-03-14 |
| Last Update Date | 2021-06-09 |