Jon C Kolstad OD, PC
Organization Active NPI Optometrist · Glasgow, MT
NPI 1700136199 · NPPES record last updated Apr 15, 2014
Key facts
- NPI
- 1700136199
- Entity type
- Organization (NPI type 2)
- Primary specialty
- Optometrist 152W00000X
- License
- 616MT (MT)
- Legal business name
- JON C KOLSTAD OD, PC
- Practice address
- 630 3Rd Ave S
Glasgow, MT 59230-2407 - Phone
- (406) 228-8641
- Fax
- (406) 228-2094
- NPI assigned
- Sep 13, 2012
- Organization subpart
- No
Authorized official
- Name
- Mr. Jon C Kolstad, O.D.
- Title
- Optometrist/Owner
- Phone
- (406) 228-8641
Corporate family (same tax ID) 1
Practitioners 1
-
Jon C Kolstad, OD PC
National Provider Directory
- Tax ID family
- Jon C Kolstad OD PC
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Optometrist |
152W00000X | 616MT | MT | Yes |
Addresses
Primary practice location
630 3Rd Ave S
Glasgow, MT 59230-2407
Mailing address
630 3Rd Ave S
Glasgow, MT 59230-2407
Phone (406) 228-8641
Other identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1639361058 | Medicaid | MT |
Other providers in Glasgow, MT
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Apr 15, 2014. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.