Healthcare Provider Details

I. General information

NPI: 1720235955
Provider Name (Legal Business Name): TRAVIS K WHITT OD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/19/2008
Last Update Date: 05/21/2024
Certification Date: 05/21/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1925 N 22ND AVE STE 201
BOZEMAN MT
59718-7020
US

IV. Provider business mailing address

3101 W 57TH ST
SIOUX FALLS SD
57108-3162
US

V. Phone/Fax

Practice location:
  • Phone: 406-219-0700
  • Fax: 605-371-7199
Mailing address:
  • Phone: 605-371-7100
  • Fax: 605-371-7199

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code152W00000X
TaxonomyOptometrist
License Number3959
License Number StateMT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: