Active NPI
Eye Clinic of Great Falls, P.C.
- Optometrist
- Great Falls, MT
National Provider Identifier
1770543779
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Optometrist
- License
- 470
- Legal business name
- EYE CLINIC OF GREAT FALLS, P.C.
- Practice address
- 509 2ND Ave N
Great Falls, MT 59401 - Phone
- (406) 452-9507
- Fax
- (406) 452-2015
- NPI assigned
- Mar 24, 2006
- Organization subpart
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Authorized official
- Name
- Mr. Patrick J Stibel, OD
- Title
- President
- Phone
- (406) 452-9507
Specialties & licenses 3
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Optometrist | 152W00000X | 470 | MT | Primary |
| Optometrist | 152W00000X | 568 | MT | |
| Optometrist | 152W00000X | 794 | MT |
Addresses
Primary practice location
509 2ND Ave N
Great Falls, MT 59401
Mailing address
PO Box 3427
Great Falls, MT 59403-3427
Phone (406) 452-9507
Other identifiers 5
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 26540 | Other | MT | BC |
| 0480480 | Medicaid | MT | |
| 25743 | Other | MT | BC |
| 0483353 | Medicaid | MT | |
| 28000 | Other | MT | BC |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Enrolled in MT
Enrollment records 2
Other NPIs with the same Medicare PAC ID 1
NPIs whose Medicare enrollments share a PECOS associate control ID (the same enrolled entity).
Other NPIs on the same Medicare enrollment 1
NPIs listed together on one Medicare enrollment, typically parts of the same organization.
Laboratory certificates & supplier records
Derived by NPIMapThese 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
| Supplier | Supplies | Medicare assignment |
|---|---|---|
| Eye Clinic of Great Falls | Prosthetic Lenses: Conventional Eyeglasses|Prosthetic Lenses: Conventional Contact Lenses|Prosthetic Lenses: Prosthetics Cataract Lenses | Accepts assignment |
National Provider Directory
National Provider Directory- Tax ID family
- Eye Clinic of Great Falls
Other organizations with this tax ID 1
Organizations that report the same tax identification number in the National Provider Directory.
-
- Optometrist
- Fort Benton, MT
- NPI 1538209390
Practitioners & affiliated clinicians
Practitioners 3
Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.
-
- Optometrist
- Great Falls, MT
- NPI 1831396548
-
- Optometrist
- Great Falls, MT
- NPI 1083910459
-
- Optometrist
- Great Falls, MT
- NPI 1487924205
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1143158400000",
"enumeration_type": "NPI-2",
"last_updated_epoch": "1304294400000",
"number": "1770543779",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "PO BOX 3427",
"city": "GREAT FALLS",
"state": "MT",
"postal_code": "594033427",
"telephone_number": "406-452-9507",
"fax_number": "406-452-2015"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "509 2ND AVE N",
"city": "GREAT FALLS",
"state": "MT",
"postal_code": "59401",
"telephone_number": "406-452-9507",
"fax_number": "406-452-2015"
}
],
"practiceLocations": [],
"basic": {
"organization_name": "EYE CLINIC OF GREAT FALLS, P.C.",
"organizational_subpart": "NO",
"enumeration_date": "2006-03-24",
"last_updated": "2011-05-02",
"status": "A",
"authorized_official_last_name": "STIBEL",
"authorized_official_first_name": "PATRICK",
"authorized_official_middle_name": "J",
"authorized_official_title_or_position": "PRESIDENT",
"authorized_official_telephone_number": "406-452-9507",
"authorized_official_name_prefix": "Mr.",
"authorized_official_credential": "OD"
},
"taxonomies": [
{
"code": "152W00000X",
"taxonomy_group": "193400000X MULTIPLE SINGLE SPECIALTY GROUP",
"desc": "Optometrist",
"state": "MT",
"license": "470",
"primary": true
},
{
"code": "152W00000X",
"taxonomy_group": "193400000X MULTIPLE SINGLE SPECIALTY GROUP",
"desc": "Optometrist",
"state": "MT",
"license": "568",
"primary": false
},
{
"code": "152W00000X",
"taxonomy_group": "193400000X MULTIPLE SINGLE SPECIALTY GROUP",
"desc": "Optometrist",
"state": "MT",
"license": "794",
"primary": false
}
],
"identifiers": [
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "BC",
"identifier": "26540",
"state": "MT"
},
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "0480480",
"state": "MT"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "BC",
"identifier": "25743",
"state": "MT"
},
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "0483353",
"state": "MT"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "BC",
"identifier": "28000",
"state": "MT"
}
],
"endpoints": [],
"other_names": []
}Other providers in Great Falls, MT
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 2, 2011; 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.