Healthcare Provider Details

I. General information

NPI: 1215066188
Provider Name (Legal Business Name): PATRICK-PURDY INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/05/2007
Last Update Date: 04/04/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

610 CALIFORNIA AVE
LIBBY MT
59923-1902
US

IV. Provider business mailing address

610 CALIFORNIA AVE
LIBBY MT
59923-1902
US

V. Phone/Fax

Practice location:
  • Phone: 406-293-6236
  • Fax: 406-293-6237
Mailing address:
  • Phone: 406-293-6236
  • Fax: 406-293-6237

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code152W00000X
TaxonomyOptometrist
License Number689
License Number StateMT

VIII. Authorized Official

Name: DR. TERRY C PATRICK
Title or Position: PRESIDENT
Credential: O.D.
Phone: 406-293-6236