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General NPI Number Information
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NPI Number | 1700136199
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Entity Type | Organization
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Legal Business Name | JON C KOLSTAD OD, PC
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Dates
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Enumeration Date | 09/13/2012
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Last Update Date | 04/15/2014
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Provider Practice Location Address
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Address Line | 630 3RD AVE S
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City | GLASGOW
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State | MT
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Zip | 59230-2407
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Country | US
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Telephone | 406-228-8641
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Fax | 406-228-2094
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Provider Business Mailing Address
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Address Line | 630 3RD AVE S
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City | GLASGOW
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State | MT
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Zip | 59230-2407
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Country | US
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Telephone | 406-228-8641
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Fax | 406-228-2094
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Authorized Official
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Title or Position | OPTOMETRIST/OWNER
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Name | MR. JON C KOLSTAD
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Credential | O.D.
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Telephone | 406-228-8641
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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 | 616MT
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License Number State | MT
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