Healthcare Provider Details

I. General information

NPI: 1043757057
Provider Name (Legal Business Name): MICHAEL CRAIG WARDELL OD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/27/2017
Last Update Date: 05/11/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1005 24TH ST W STE 8
BILLINGS MT
59102-3800
US

IV. Provider business mailing address

1005 24TH ST W STE 8
BILLINGS MT
59102-3800
US

V. Phone/Fax

Practice location:
  • Phone: 406-281-8180
  • Fax:
Mailing address:
  • Phone: 406-281-8480
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code152WC0802X
TaxonomyCorneal and Contact Management Optometrist
License Number2937
License Number StateMT
# 2
Primary TaxonomyN
Taxonomy Code152WV0400X
TaxonomyVision Therapy Optometrist
License Number2937
License Number StateMT
# 3
Primary TaxonomyY
Taxonomy Code152W00000X
TaxonomyOptometrist
License Number2937
License Number StateMT
# 4
Primary TaxonomyN
Taxonomy Code152WP0200X
TaxonomyPediatric Optometrist
License Number2937
License Number StateMT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: