| NPI | 1639361058 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | JON CHRISTOPHER KOLSTAD Owner 406-228-8641 |
| Organization Subpart ? | No |
| Primary Taxonomy | 152W00000X Optometrist (Licence: MT 616) |
| Additional Taxonomies | 152WC0802X Optometrist, Corneal and Contact Management (Licence: MT 616) |
| 152WL0500X Optometrist, Low Vision Rehabilitation (Licence: MT 616) | |
| 152WP0200X Optometrist, Pediatrics (Licence: MT 616) | |
| 152WS0006X Optometrist, Sports Vision (Licence: MT 616) | |
| 152WV0400X Optometrist, Vision Therapy (Licence: MT 616) | |
| 152WX0102X Optometrist, Occupational Vision (Licence: MT 616) | |
| Enumeration Date | 2007-08-10 |
| Last Update Date | 2008-01-03 |