Healthcare Provider Details

I. General information

NPI: 1285606426
Provider Name (Legal Business Name): LARRY G OBIE OD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/02/2006
Last Update Date: 07/16/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

419 PENNSYLVANIA ST
CHINOOK MT
59523
US

IV. Provider business mailing address

PO BOX 1569
CHINOOK MT
59523-1569
US

V. Phone/Fax

Practice location:
  • Phone: 406-357-3740
  • Fax: 406-357-3640
Mailing address:
  • Phone: 406-357-3740
  • Fax: 406-357-3640

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code152W00000X
TaxonomyOptometrist
License Number423
License Number StateMT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: