Healthcare Provider Details

I. General information

NPI: 1811105778
Provider Name (Legal Business Name): JOY SAXON POPPELL O.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/21/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1900 4TH ST NE STE 5
GREAT FALLS MT
59404-1960
US

IV. Provider business mailing address

1106 LOCUST ST # 2
GREAT FALLS MT
59405-7975
US

V. Phone/Fax

Practice location:
  • Phone: 406-453-1900
  • Fax:
Mailing address:
  • Phone: 406-952-4065
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code152W00000X
TaxonomyOptometrist
License Number785
License Number StateMT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: