Healthcare Provider Details

I. General information

NPI: 1730344698
Provider Name (Legal Business Name): DEVIN BURTON DESPAIN O.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/21/2008
Last Update Date: 08/29/2023
Certification Date: 08/29/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1540 LAKE ELMO DR STE 1
BILLINGS MT
59105-1798
US

IV. Provider business mailing address

1540 LAKE ELMO DR STE 1
BILLINGS MT
59105-1798
US

V. Phone/Fax

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

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code152WP0200X
TaxonomyPediatric Optometrist
License Number800
License Number StateMT
# 2
Primary TaxonomyY
Taxonomy Code152W00000X
TaxonomyOptometrist
License Number800
License Number StateMT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: