Healthcare Provider Details

I. General information

NPI: 1225209513
Provider Name (Legal Business Name): ADVANCED EYECARE LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/14/2008
Last Update Date: 06/09/2021
Certification Date: 06/09/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4265 FALLON ST STE 1
BOZEMAN MT
59718-6797
US

IV. Provider business mailing address

91 W MADISON AVE STE B
BELGRADE MT
59714-3915
US

V. Phone/Fax

Practice location:
  • Phone: 406-577-2507
  • Fax: 406-587-0396
Mailing address:
  • Phone: 406-388-1988
  • Fax: 406-388-2488

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code152W00000X
TaxonomyOptometrist
License Number0492
License Number StateMT
# 2
Primary TaxonomyN
Taxonomy Code332BC3200X
TaxonomyCustomized Equipment (DME)
License Number
License Number State

VIII. Authorized Official

Name: SONIA K BECKER
Title or Position: CREDENTIALING
Credential:
Phone: 406-577-2507