Healthcare Provider Details

I. General information

NPI: 1619730249
Provider Name (Legal Business Name): ELECTRIC CITY EYES
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/05/2024
Last Update Date: 02/19/2024
Certification Date: 02/19/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

905 10TH AVE S
GREAT FALLS MT
59405-4420
US

IV. Provider business mailing address

3604 2ND AVE S
GREAT FALLS MT
59405-3559
US

V. Phone/Fax

Practice location:
  • Phone: 406-204-0074
  • Fax: 406-204-0075
Mailing address:
  • Phone: 406-204-0074
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code152W00000X
TaxonomyOptometrist
License Number
License Number State

VIII. Authorized Official

Name: DR. AUDRA SEXTON
Title or Position: OPTOMETRIST
Credential: O.D.
Phone: 605-484-9760