Provider Demographics
NPI:1770543779
Name:EYE CLINIC OF GREAT FALLS, P.C.
Entity type:Organization
Organization Name:EYE CLINIC OF GREAT FALLS, P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:PATRICK
Authorized Official - Middle Name:J
Authorized Official - Last Name:STIBEL
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:406-452-9507
Mailing Address - Street 1:PO BOX 3427
Mailing Address - Street 2:
Mailing Address - City:GREAT FALLS
Mailing Address - State:MT
Mailing Address - Zip Code:59403-3427
Mailing Address - Country:US
Mailing Address - Phone:406-452-9507
Mailing Address - Fax:406-452-2015
Practice Address - Street 1:509 2ND AVE N
Practice Address - Street 2:
Practice Address - City:GREAT FALLS
Practice Address - State:MT
Practice Address - Zip Code:59401
Practice Address - Country:US
Practice Address - Phone:406-452-9507
Practice Address - Fax:406-452-2015
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-03-24
Last Update Date:2011-05-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MT568152W00000X
MT794152W00000X
MT470152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MT26540OtherBC
MT0480480Medicaid
MT25743OtherBC
MT0483353Medicaid
MT28000OtherBC
U34104Medicare UPIN
MT0276530001Medicare NSC
MT26540OtherBC
MT28000OtherBC
T89257Medicare UPIN