Provider Demographics
NPI:1730275413
Name:MONTAGUE, JAMES K (OD)
Entity type:Individual
Prefix:
First Name:JAMES
Middle Name:K
Last Name:MONTAGUE
Suffix:
Gender:M
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 198
Mailing Address - Street 2:
Mailing Address - City:SKIPPACK
Mailing Address - State:PA
Mailing Address - Zip Code:19474-0198
Mailing Address - Country:US
Mailing Address - Phone:610-584-4544
Mailing Address - Fax:
Practice Address - Street 1:2012 BRIDGE ROAD
Practice Address - Street 2:
Practice Address - City:SKIPPACK
Practice Address - State:PA
Practice Address - Zip Code:19474-0198
Practice Address - Country:US
Practice Address - Phone:610-584-4544
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-04
Last Update Date:2008-01-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAOEG000141152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
PAT28299Medicare UPIN
PA4632070001Medicare NSC
PA083045Medicare PIN