Healthcare Provider Details

I. General information

NPI: 1649318007
Provider Name (Legal Business Name): BILLINGS FAMILY EYECARE, PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/01/2007
Last Update Date: 03/06/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1540 LAKE ELMO DR SUITE 1
BILLINGS MT
59105-1797
US

IV. Provider business mailing address

1540 LAKE ELMO DR SUITE 1
BILLINGS MT
59105-1797
US

V. Phone/Fax

Practice location:
  • Phone: 406-245-2299
  • Fax: 406-245-8302
Mailing address:
  • Phone: 406-245-2299
  • Fax: 406-245-8302

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code152W00000X
TaxonomyOptometrist
License Number419
License Number StateMT

VIII. Authorized Official

Name: DR. MICHAEL A. HANSEN
Title or Position: PRESIDENT
Credential: O.D.
Phone: 406-245-2299