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General NPI Number Information
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NPI Number | 1639431588
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Entity Type | Organization
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Legal Business Name | ENNIS EYE CLINIC
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Dates
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Enumeration Date | 06/15/2012
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Last Update Date | 06/15/2012
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Provider Practice Location Address
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Address Line | 219 E. MAIN ST.
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City | ENNIS
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State | MT
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Zip | 59792
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Country | US
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Telephone | 406-682-4208
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Fax |
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Provider Business Mailing Address
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Address Line | 316 S 5TH AVE
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City | BOZEMAN
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State | MT
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Zip | 59715-4517
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Country | US
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Telephone | 812-322-6632
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Fax |
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Authorized Official
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Title or Position | OWNER/OPTOMETRIST
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Name | DR. SARAH QUINTON KIRKPATRICK
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Credential | O.D.
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Telephone | 406-682-4208
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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 | 811
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License Number State | MT
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