Healthcare Provider Details

I. General information

NPI: 1659316255
Provider Name (Legal Business Name): KYLE D MCMURRAY OD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/18/2006
Last Update Date: 12/10/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

91 W MADISON AVE STE B
BELGRADE MT
59714-3915
US

IV. Provider business mailing address

91 W MADISON AVE STE B
BELGRADE MT
59714-3915
US

V. Phone/Fax

Practice location:
  • Phone: 406-388-1988
  • Fax: 406-388-2488
Mailing address:
  • Phone: 406-388-1988
  • Fax: 406-388-2488

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code152W00000X
TaxonomyOptometrist
License Number492
License Number StateMT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: