Healthcare Provider Details

I. General information

NPI: 1780695387
Provider Name (Legal Business Name): ROCKY MOUNTAIN OPTICAL & CONTACT LENS CENTER, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/10/2006
Last Update Date: 02/12/2024
Certification Date: 02/12/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

700 WEST KENT
MISSOULA MT
59801
US

IV. Provider business mailing address

PO BOX 4907
MISSOULA MT
59806
US

V. Phone/Fax

Practice location:
  • Phone: 406-541-3918
  • Fax: 406-541-3813
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: KIM BROE
Title or Position: BILLING MANAGER
Credential:
Phone: 406-541-3806