=====================================================
General NPI Number Information
=====================================================
NPI Number | 1649318007
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | BILLINGS FAMILY EYECARE, PC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 02/01/2007
-----------------------------------------------------
Last Update Date | 03/06/2009
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 1540 LAKE ELMO DR SUITE 1
-----------------------------------------------------
City | BILLINGS
-----------------------------------------------------
State | MT
-----------------------------------------------------
Zip | 59105-1797
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 406-245-2299
-----------------------------------------------------
Fax | 406-245-8302
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 1540 LAKE ELMO DR SUITE 1
-----------------------------------------------------
City | BILLINGS
-----------------------------------------------------
State | MT
-----------------------------------------------------
Zip | 59105-1797
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 406-245-2299
-----------------------------------------------------
Fax | 406-245-8302
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | PRESIDENT
-----------------------------------------------------
Name | DR. MICHAEL A. HANSEN
-----------------------------------------------------
Credential | O.D.
-----------------------------------------------------
Telephone | 406-245-2299
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 152W00000X
-----------------------------------------------------
Taxonomy Name | Optometrist
-----------------------------------------------------
License Number | 419
-----------------------------------------------------
License Number State | MT
-----------------------------------------------------