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General NPI Number Information
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NPI Number | 1558719104
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Entity Type | Organization
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Legal Business Name | DR. KENNETH A. ETHIER OD PC
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Dates
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Enumeration Date | 05/24/2016
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Last Update Date | 10/27/2025
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Provider Practice Location Address
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Address Line | 1525 10TH AVE S
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City | GREAT FALLS
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State | MT
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Zip | 59405-2608
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Country | US
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Telephone | 406-791-5139
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Fax | 406-453-5701
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Provider Business Mailing Address
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Address Line | 1525 10TH AVE S
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City | GREAT FALLS
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State | MT
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Zip | 59405-2608
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Country | US
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Telephone | 406-791-5139
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Fax | 406-453-5701
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Authorized Official
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Title or Position | OPTOMETRIST
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Name | DR. KENNETH A. ETHIER
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Credential | OD PC
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Telephone | 406-791-5139
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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 | 751
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License Number State | MT
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