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General NPI Number Information
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NPI Number | 1194908624
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Entity Type | Organization
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Legal Business Name | MONTANA FAMILY VISION CARE, PC
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Dates
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Enumeration Date | 12/06/2007
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Last Update Date | 08/23/2010
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Provider Practice Location Address
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Address Line | 2829 GREAT NORTHERN LOOP SUITE 100
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City | MISSOULA
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State | MT
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Zip | 59808-1752
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Country | US
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Telephone | 406-542-6382
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Fax | 406-542-4773
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Provider Business Mailing Address
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Address Line | 2829 GREAT NORTHERN LOOP SUITE 100
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City | MISSOULA
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State | MT
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Zip | 59808-1752
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Country | US
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Telephone | 406-542-6382
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Fax | 406-542-4773
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Authorized Official
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Title or Position | OWNER
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Name | DR. THOMAS D HALL
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Credential | O.D.
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Telephone | 406-542-6382
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 152W00000X
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Taxonomy Name | Optometrist
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License Number | 671
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License Number State | MT
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