=====================================================
General NPI Number Information
=====================================================
NPI Number | 1053342006
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | LEONARD E. VAINIO & DAVID G. VAINIO PC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 07/06/2006
-----------------------------------------------------
Last Update Date | 07/31/2014
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 100 W PARK AVE
-----------------------------------------------------
City | ANACONDA
-----------------------------------------------------
State | MT
-----------------------------------------------------
Zip | 59711-2259
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 406-563-6471
-----------------------------------------------------
Fax | 406-563-7252
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 100 W PARK AVE
-----------------------------------------------------
City | ANACONDA
-----------------------------------------------------
State | MT
-----------------------------------------------------
Zip | 59711-2259
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 406-563-6471
-----------------------------------------------------
Fax | 406-563-7252
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OPTOMETRIST
-----------------------------------------------------
Name | DR. DAVID G VAINIO
-----------------------------------------------------
Credential | O.D.
-----------------------------------------------------
Telephone | 406-563-6471
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 152W00000X
-----------------------------------------------------
Taxonomy Name | Optometrist
-----------------------------------------------------
License Number | 490
-----------------------------------------------------
License Number State | MT
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 207W00000X
-----------------------------------------------------
Taxonomy Name | Ophthalmology Physician
-----------------------------------------------------
License Number | 3128
-----------------------------------------------------
License Number State | MT
-----------------------------------------------------
Taxonomy #3
-----------------------------------------------------
Taxonomy Code | 152W00000X
-----------------------------------------------------
Taxonomy Name | Optometrist
-----------------------------------------------------
License Number | 426
-----------------------------------------------------
License Number State | MT
-----------------------------------------------------