Healthcare Provider Details

I. General information

NPI: 1861328122
Provider Name (Legal Business Name): GRACE VON KROSIGK
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/23/2026
Last Update Date: 06/23/2026
Certification Date: 06/23/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

430 LAKE ELMO DR
BILLINGS MT
59105-3027
US

IV. Provider business mailing address

145 N CONNOR ST STE 5
SHERIDAN WY
82801-4348
US

V. Phone/Fax

Practice location:
  • Phone: 406-252-9927
  • Fax:
Mailing address:
  • Phone: 307-763-6334
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code152W00000X
TaxonomyOptometrist
License NumberOPT-OPT-LIC-5957
License Number StateMT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: