3 Rivers Eyecare LLC
Organization Active NPI Optometrist · Missoula, MT
NPI 1679980965 · NPPES record last updated Jul 17, 2014
Key facts
- NPI
- 1679980965
- Entity type
- Organization (NPI type 2)
- Primary specialty
- Optometrist 152W00000X
- License
- 2200 (MT)
- Legal business name
- 3 RIVERS EYECARE LLC
- Practice address
- 700 South Ave W
Ste G
Missoula, MT 59801-8000 - Phone
- (406) 549-4851
- NPI assigned
- Jul 17, 2014
- Organization subpart
- No
Authorized official
- Name
- Dr. Matthew Burgess, O.D.
- Title
- Owner
- Phone
- (406) 549-4851
Practitioners 3
-
Matthew Evan Burgess, O.D.
-
Caitlin Jean Campbell, O.D.
-
Sandy Sheppard, OD PC
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in MT
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| O20150129000686 | MT | Part B Supplier - Clinic/Group Practice | 8426372194 |
Receives reassigned benefits from 2 practitioners Practice locations: Missoula, MT |
National Provider Directory
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Optometrist |
152W00000X | 2200 | MT | Yes |
Addresses
Primary practice location
700 South Ave W
Ste G
Missoula, MT 59801-8000
Mailing address
700 South Ave W
Ste G
Missoula, MT 59801-8000
Other providers in Missoula, MT
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Jul 17, 2014. 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.