Provider Demographics
NPI:1831397157
Name:GLASGOW VISION CENTER
Entity type:Organization
Organization Name:GLASGOW VISION CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PARTNER
Authorized Official - Prefix:DR
Authorized Official - First Name:ROGER
Authorized Official - Middle Name:
Authorized Official - Last Name:ANDERSON
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:406-228-8200
Mailing Address - Street 1:839 1ST AVE S
Mailing Address - Street 2:
Mailing Address - City:GLASGOW
Mailing Address - State:MT
Mailing Address - Zip Code:59230-2262
Mailing Address - Country:US
Mailing Address - Phone:406-228-8200
Mailing Address - Fax:406-228-8200
Practice Address - Street 1:839 1ST AVE S
Practice Address - Street 2:
Practice Address - City:GLASGOW
Practice Address - State:MT
Practice Address - Zip Code:59230-2262
Practice Address - Country:US
Practice Address - Phone:406-228-8200
Practice Address - Fax:406-228-8200
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-07-08
Last Update Date:2007-07-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MT414152W00000X
MT453152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MT04-80-097Medicaid
MT26991OtherBLUE CROSS BLUE SHIELD
MT04-80-148Medicaid
MT26871OtherBLUE CROSS BLUE SHIELD
MT1184500001OtherDMERC