Healthcare Provider Details

I. General information

NPI: 1205271053
Provider Name (Legal Business Name): WARDELL VISION CENTER, PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/07/2013
Last Update Date: 08/25/2017
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: 406-281-8480
  • Fax: 406-281-8481
Mailing address:
  • Phone: 406-281-8480
  • Fax: 406-281-8481

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code302F00000X
TaxonomyExclusive Provider Organization
License Number528
License Number StateMT
# 2
Primary TaxonomyY
Taxonomy Code152W00000X
TaxonomyOptometrist
License Number528
License Number StateMT

VIII. Authorized Official

Name: MICHAEL B. WARDELL
Title or Position: DOCTOR/OWNER
Credential: O.D.
Phone: 406-281-8480