Northwest Family Eye Care

Primary specialty

OptometristTaxonomy code 152W00000X

Legal business name

NORTHWEST FAMILY EYE CARE

Practice address

610 California Ave
Libby, MT 59923-1902

Phone

(406) 293-6236

NPI assigned

Aug 3, 2021

Organization subpart

No

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

Authorized official

Name

Tanner Lightbourne, ODNPI 1164092425

Title

President

Phone

(406) 293-6236

Specialties & licenses 1

Addresses

Other identifiers 2

Medicare fee-for-service enrollment

Enrolled in MT2 enrollments

Enrollment records 2

These CMS records do not include an NPI. They are shown because their name and street address match this provider’s.

Medicare medical equipment & supply locations

Locations

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

• Tanner Lightbourne, OD

  • Optometrist
  • Libby, MT
  • NPI 1164092425
  Medicare reassignment NPD Authorized official

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

{
    "created_epoch": "1627948800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1636588800000",
    "number": "1407520562",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "610 CALIFORNIA AVE",
            "city": "LIBBY",
            "state": "MT",
            "postal_code": "599231902",
            "telephone_number": "406-293-6236"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "610 CALIFORNIA AVE",
            "city": "LIBBY",
            "state": "MT",
            "postal_code": "599231902",
            "telephone_number": "406-293-6236"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "NORTHWEST FAMILY EYE CARE",
        "organizational_subpart": "NO",
        "enumeration_date": "2021-08-03",
        "last_updated": "2021-11-11",
        "certification_date": "2021-11-11",
        "status": "A",
        "authorized_official_last_name": "LIGHTBOURNE",
        "authorized_official_first_name": "TANNER",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "406-293-6236",
        "authorized_official_credential": "OD"
    },
    "taxonomies": [
        {
            "code": "152W00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Optometrist",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "PERSONAL NPI NUMBER",
            "identifier": "1164092425",
            "state": "MT"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "OPTOMETRY LICENSE NUMBER",
            "identifier": "4229",
            "state": "MT"
        }
    ],
    "endpoints": [],
    "other_names": []
}

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• Optometrist in Libby, MT
• Providers in Libby, MT by specialty
• Optometrist in Montana

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 11, 2021; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.