Healthcare Provider Details

I. General information

NPI: 1487816302
Provider Name (Legal Business Name): RAVALLI FAMILY EYE CARE, PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/01/2008
Last Update Date: 07/07/2025
Certification Date: 07/07/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1031 MAIN ST
CORVALLIS MT
59828-9374
US

IV. Provider business mailing address

1031 MAIN ST
CORVALLIS MT
59828-9374
US

V. Phone/Fax

Practice location:
  • Phone: 406-363-1530
  • Fax:
Mailing address:
  • Phone: 406-363-1530
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code332H00000X
TaxonomyEyewear Supplier
License Number599OPT
License Number StateMT

VIII. Authorized Official

Name: DR. JOHN D. HUTCHISON
Title or Position: PRESIDENT
Credential: OD
Phone: 406-363-1530