Individual provider Active NPI

Mark Wayne Mutter II, OD

  • Optometrist
  • Missoula, MT
National Provider Identifier
1023690757
Registry record updated Dec 8, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
OptometristTaxonomy code 152W00000X
License
4079 Issued in MT
Practice address
700 W Kent Ave
Missoula, MT 59801-6772
Phone
(406) 541-3937
Fax
(406) 541-3811
NPI assigned
Apr 22, 2021
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Dec 8, 2023

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Optometrist 152W00000X 4079 MT Primary

Addresses

Primary practice location

700 W Kent Ave
Missoula, MT 59801-6772

Mailing address

700 W Kent Ave
Missoula, MT 59801-6772
Phone (406) 541-3937

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in MT
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: Yes
  • Power mobility devices: No
  • Hospice: Yes
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20210609003497 MT Practitioner - Optometry 0840690079 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Optometry
Education
Other, 2017
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Rocky Mountain Eye Center PCGroup PAC ID 7416986542, 16 clinicians

Practice addresses (Care Compare)

700 W Kent Ave
Missoula, MT 59801-6772
Phone (406) 541-3937

Merit-based Incentive Payment System (MIPS)

Final score
87.49 of 100Reported as group
Quality
86.46
Promoting interoperability
95
Improvement activities
40
Cost
76

Procedures performed for Medicare patients

ProcedureNumber of procedures
Cataract surgery1-10

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
4079MTMDOptometrist

Practice roles

OrganizationSpecialtyStatusNew patients
Rocky Mountain Eye Center PC Optometrist CurrentSince Jun 1, 2021 Accepting new patients

Locations

700 W Kent Ave
Missoula, MT 59801
Phone (406) 541-3277

Organizations & group practices 1

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1619049600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1701993600000",
    "number": "1023690757",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "700 W KENT AVE",
            "city": "MISSOULA",
            "state": "MT",
            "postal_code": "598016772",
            "telephone_number": "406-541-3937",
            "fax_number": "406-541-3811"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "700 W KENT AVE",
            "city": "MISSOULA",
            "state": "MT",
            "postal_code": "598016772",
            "telephone_number": "406-541-3937",
            "fax_number": "406-541-3811"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MUTTER",
        "first_name": "MARK",
        "middle_name": "WAYNE",
        "name_suffix": "II",
        "credential": "OD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2021-04-22",
        "last_updated": "2023-12-08",
        "certification_date": "2023-12-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "152W00000X",
            "taxonomy_group": "",
            "desc": "Optometrist",
            "state": "MT",
            "license": "4079",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Missoula, MT

Sources for this page

Verify at the official NPI Registry.