Basic Information
| Provider Information | |||||||||
| NPI: | 1780695387 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | ROCKY MOUNTAIN OPTICAL & CONTACT LENS CENTER, INC. | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 4907 | ||||||||
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| City: | MISSOULA | ||||||||
| State: | MT | ||||||||
| PostalCode: | 59806 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4065413937 | ||||||||
| FaxNumber: | 4065413811 | ||||||||
| Practice Location | |||||||||
| Address1: | 700 WEST KENT | ||||||||
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| City: | MISSOULA | ||||||||
| State: | MT | ||||||||
| PostalCode: | 59801 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4065413918 | ||||||||
| FaxNumber: | 4065413813 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 08/10/2006 | ||||||||
| LastUpdateDate: | 10/11/2016 | ||||||||
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| AuthorizedOfficialLastName: | BROE | ||||||||
| AuthorizedOfficialFirstName: | KIM | ||||||||
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| AuthorizedOfficialTitleorPosition: | BILLING MANAGER | ||||||||
| AuthorizedOfficialTelephone: | 4065413806 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 156FX1800X | Y | 193400000X SINGLE SPECIALTY GROUP | Eye and Vision Services Providers | Technician/Technologist | Optician |
No ID Information.