Healthcare Provider Details

I. General information

NPI: 1992634729
Provider Name (Legal Business Name): BEN MALMANGER OD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/18/2026
Last Update Date: 05/18/2026
Certification Date: 05/18/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

120 S 5TH ST STE 104
HAMILTON MT
59840-2798
US

IV. Provider business mailing address

700 W KENT AVE
MISSOULA MT
59801-6772
US

V. Phone/Fax

Practice location:
  • Phone: 406-363-3366
  • Fax: 406-541-3811
Mailing address:
  • Phone: 406-541-3937
  • Fax: 406-541-3811

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code152W00000X
TaxonomyOptometrist
License NumberOPT-OPT-LIC-5685
License Number StateMT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: