Advanced Eyecare LLC
Organization Active NPI Optometrist · Bozeman, MT
NPI 1629283155 · NPPES record last updated Dec 30, 2020
Key facts
- NPI
- 1629283155
- Entity type
- Organization (NPI type 2)
- Primary specialty
- Optometrist 152W00000X
- Legal business name
- ADVANCED EYECARE LLC
- Practice address
- 4265 Fallon St
Suite 1
Bozeman, MT 59718-6756 - Phone
- (406) 587-0668
- Fax
- (406) 587-0396
- NPI assigned
- May 10, 2007
- Organization subpart
- No
Authorized official
- Name
- Sonia K Becker
- Title
- Insurance Credentialing
- Phone
- (406) 577-2507
Other NPIs on the same Medicare enrollment 1
Subparts reporting this organization as parent 1
Practitioners 8
-
Jody Lynn Fink, O.D.
-
Jennipher Rae Harper, O.D.
-
Tel Michael Todd, OD
-
Linda Tran Knutson, O.D.
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in MT
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| O20040708000809 | MT | Part B Supplier - Clinic/Group Practice | 0840288056 |
Receives reassigned benefits from 7 practitioners 1 other NPI on this enrollment Practice locations: Belgrade, MT; Bozeman, MT |
National Provider Directory
Locations
100 W Park Ave
Anaconda, MT 59711
Phone (406) 563-6471
91 W Madison Ave
Belgrade, MT 59714
Phone (406) 388-1988
4265 Fallon St
Bozeman, MT 59718
Phone (406) 587-0668
4265 Fallon St
Ste 1
Bozeman, MT 59718
Phone (406) 577-2507
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Optometrist |
152W00000X | MT | Yes |
Addresses
Primary practice location
4265 Fallon St
Suite 1
Bozeman, MT 59718-6756
Mailing address
4265 Fallon St.
Suite 1
Bozeman, MT 59718-6756
Phone (406) 587-0668
Other practice location 1
91 W Madison Ave
Belgrade, MT 59714-3915
Phone (406) 388-1988
Other identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 0483288 | Medicaid | MT |
Other providers in Bozeman, MT
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Dec 30, 2020. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.