Healthcare Provider Details

I. General information

NPI: 1982749362
Provider Name (Legal Business Name): HAVRE OPTOMETRIC CLINIC, PLLP
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/21/2007
Last Update Date: 07/06/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

416 3RD AVE
HAVRE MT
59501-3914
US

IV. Provider business mailing address

PO BOX 551
HAVRE MT
59501-0551
US

V. Phone/Fax

Practice location:
  • Phone: 406-265-1231
  • Fax: 406-265-1603
Mailing address:
  • Phone: 406-265-1231
  • Fax: 406-265-1603

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code152W00000X
TaxonomyOptometrist
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code332H00000X
TaxonomyEyewear Supplier
License Number
License Number StateMT

VIII. Authorized Official

Name: DR. DOUGLAS A SAFLEY
Title or Position: PARTNER
Credential: OD
Phone: 406-265-1231