Healthcare Provider Details
I. General information
NPI: 1619173580
Provider Name (Legal Business Name): TRUE VISION CLINIC PLLC
Entity Type: Organization
Gender:
Sole Proprietor:
II. Dates (important events)
Enumeration Date: 06/26/2007
Last Update Date: 08/30/2010
Certification Date:
Deactivation Date:
Reactivation Date:
III. Provider practice location address
1900 4TH ST NE SUITE 5
GREAT FALLS MT
59404-1996
US
IV. Provider business mailing address
1900 4TH ST NE SUITE 5
GREAT FALLS MT
59404-1996
US
V. Phone/Fax
- Phone: 406-453-1900
- Fax: 406-453-1700
- Phone: 406-453-1900
- Fax: 406-453-1700
VI. Provider taxonomy
Scope of Practice (Provider specialty)
| # 1 | |
| Primary Taxonomy | Y |
| Taxonomy Code | 332H00000X |
| Taxonomy | Eyewear Supplier |
| License Number | |
| License Number State | |
VIII. Authorized Official
Name: DR.
MORGAN
R.
LEACH
Title or Position: OWNER
Credential: O.D.
Phone: 406-453-1900