Healthcare Provider Details

I. General information

NPI: 1831016583
Provider Name (Legal Business Name): KAYLEE WILLNER OD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/02/2026
Last Update Date: 07/23/2026
Certification Date: 07/23/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1010 7650 E
CROW AGENCY MT
59022
US

IV. Provider business mailing address

1010 7650 E
CROW AGENCY MT
59022
US

V. Phone/Fax

Practice location:
  • Phone: 406-638-3500
  • Fax:
Mailing address:
  • Phone: 406-638-3500
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code152W00000X
TaxonomyOptometrist
License NumberOPT-OPT-LIC-5922
License Number StateMT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: