Healthcare Provider Details

I. General information

NPI: 1780047399
Provider Name (Legal Business Name): CONNIE PLOYHAR OPTICIAN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/31/2016
Last Update Date: 03/31/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

700 WEST KENT
MISSOULA MT
59801-6719
US

IV. Provider business mailing address

PO BOX 4907 700 WEST KENT
MISSOULA MT
59801-6719
US

V. Phone/Fax

Practice location:
  • Phone: 406-541-3937
  • 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 Code156FX1800X
TaxonomyOptician
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: