Chad Krezelok O.D. PLLC

Primary specialty

OptometristTaxonomy code 152W00000X

License

0782 Issued in MT

Legal business name

CHAD KREZELOK O.D. PLLC

Practice address

1500 N 7TH Ave
Bozeman, MT 59715-2557

Phone

(406) 585-8153

NPI assigned

Oct 19, 2016

Last updated

Oct 19, 2016By the provider in NPPES

Organization subpart

No

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

Authorized official

Name

Maci Clark

Title

Office Manager

Phone

(406) 585-8153

Specialties & licenses 1

Addresses

Locations

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

{
    "created_epoch": "1476835200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1476835200000",
    "number": "1235680760",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1500 N 7TH AVE",
            "city": "BOZEMAN",
            "state": "MT",
            "postal_code": "597152557",
            "telephone_number": "406-585-8153"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1500 N 7TH AVE",
            "city": "BOZEMAN",
            "state": "MT",
            "postal_code": "597152557",
            "telephone_number": "406-585-8153"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "CHAD KREZELOK O.D. PLLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2016-10-19",
        "last_updated": "2016-10-19",
        "status": "A",
        "authorized_official_last_name": "CLARK",
        "authorized_official_first_name": "MACI",
        "authorized_official_title_or_position": "OFFICE MANAGER",
        "authorized_official_telephone_number": "406-585-8153"
    },
    "taxonomies": [
        {
            "code": "152W00000X",
            "taxonomy_group": "",
            "desc": "Optometrist",
            "state": "MT",
            "license": "0782",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 19, 2016; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.