Healthcare Provider Details

I. General information

NPI: 1275563678
Provider Name (Legal Business Name): ARNT JAMES OFSTAD O.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/03/2006
Last Update Date: 10/26/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

417 MAIN ST SW
RONAN MT
59864-2738
US

IV. Provider business mailing address

417 MAIN ST SW
RONAN MT
59864-2738
US

V. Phone/Fax

Practice location:
  • Phone: 406-676-8921
  • Fax: 406-676-3938
Mailing address:
  • Phone: 406-676-8921
  • Fax: 406-676-3938

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code152W00000X
TaxonomyOptometrist
License Number381OPT
License Number StateMT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: