Healthcare Provider Details

I. General information

NPI: 1396398442
Provider Name (Legal Business Name): BIG SKY EYES PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/18/2019
Last Update Date: 10/11/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

99 TOWN CENTER AVE, UNIT #A6
BIG SKY MT
59716-0700
US

IV. Provider business mailing address

99 TOWN CENTER AVE, UNIT #A6 P.O. BOX # 160700
BIG SKY MT
59716
US

V. Phone/Fax

Practice location:
  • Phone: 406-414-0006
  • Fax: 406-414-0004
Mailing address:
  • Phone: 406-414-0006
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code152WC0802X
TaxonomyCorneal and Contact Management Optometrist
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code152WL0500X
TaxonomyLow Vision Rehabilitation Optometrist
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code152WP0200X
TaxonomyPediatric Optometrist
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code152WS0006X
TaxonomySports Vision Optometrist
License Number
License Number State
# 5
Primary TaxonomyN
Taxonomy Code152WX0102X
TaxonomyOccupational Vision Optometrist
License Number
License Number State
# 6
Primary TaxonomyY
Taxonomy Code152W00000X
TaxonomyOptometrist
License Number
License Number State

VIII. Authorized Official

Name: DR. ERICA PERLMAN - HENSEN
Title or Position: DOCTOR
Credential: OD
Phone: 909-576-6398