=====================================================
General NPI Number Information
=====================================================
NPI Number | 1063865590
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | ERICA PERLMAN - HENSEN O.D.
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 07/20/2016
-----------------------------------------------------
Last Update Date | 09/26/2019
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 99 TOWN CENTER AVE, UNIT #A6
-----------------------------------------------------
City | BIG SKY
-----------------------------------------------------
State | MT
-----------------------------------------------------
Zip | 59716-0700
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 406-414-0006
-----------------------------------------------------
Fax | 406-414-0004
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 99 TOWN CENTER AVE, UNIT #A6 P.O. BOX # 160700
-----------------------------------------------------
City | BIG SKY
-----------------------------------------------------
State | MT
-----------------------------------------------------
Zip | 59716-0700
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 406-414-0006
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 152W00000X
-----------------------------------------------------
Taxonomy Name | Optometrist
-----------------------------------------------------
License Number | 33544
-----------------------------------------------------
License Number State | CA
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 152W00000X
-----------------------------------------------------
Taxonomy Name | Optometrist
-----------------------------------------------------
License Number | 3390
-----------------------------------------------------
License Number State | MT
-----------------------------------------------------