Healthcare Provider Details

I. General information

NPI: 1508533969
Provider Name (Legal Business Name): 406 ROLLIN' EYES
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/24/2021
Last Update Date: 08/06/2024
Certification Date: 08/06/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1844 BROADWATER AVE STE 5
BILLINGS MT
59102-4875
US

IV. Provider business mailing address

1844 BROADWATER AVE STE 5
BILLINGS MT
59102-4875
US

V. Phone/Fax

Practice location:
  • Phone: 406-797-2020
  • Fax: 406-797-7227
Mailing address:
  • Phone: 406-797-2020
  • Fax: 406-797-7227

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code332H00000X
TaxonomyEyewear Supplier
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License Number
License Number State

VIII. Authorized Official

Name: MRS. SALICIA BORGES
Title or Position: OWNER/ABO CERTIFIED OPTICIAN
Credential:
Phone: 406-797-2020