MEDICARE: CENTRAL MONTANA EYECARE PC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	152W00000X	Optometrist

General Provider Information

NPI Number	:	1083015358
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	CENTRAL MONTANA EYECARE PC

Provider Business Mailing Address
First Line	:	2012 14TH ST SW
Second Line	:
City	:	GREAT FALLS
State	:	MT
Zip	:	59404-3486
Country	:	US
Telephone Number	:	406-453-1900
Fax Number	:	406-453-1700

Provider Business Practice Location Address
First Line	:	2012 14TH ST SW
Second Line	:
City	:	GREAT FALLS
State	:	MT
Zip	:	59404-3486
Country	:	US
Telephone Number	:	406-453-1900
Fax Number	:	406-453-1700

Authorized Official
Title or Position	:	OWNER/OPERATOR
Name	:	DR. MORGAN R LEACH
Credential	:	OD
Telephone Number	:	406-453-1900

Provider Enumeration Date	:	09/05/2014
Last Update Date	:	09/05/2014

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