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General NPI Number Information
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NPI Number | 1780274506
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Entity Type | Organization
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Legal Business Name | JEC LLC
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Dates
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Enumeration Date | 01/25/2021
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Last Update Date | 01/25/2021
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Provider Practice Location Address
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Address Line | 1200 W KENT AVE STE 101
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City | MISSOULA
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State | MT
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Zip | 59801-6609
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Country | US
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Telephone | 406-272-0453
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Fax | 406-221-3754
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Provider Business Mailing Address
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Address Line | 409 AGNES AVE
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City | MISSOULA
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State | MT
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Zip | 59801-8746
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Country | US
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Telephone | 406-546-6854
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Fax | 406-221-3754
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Authorized Official
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Title or Position | OPTOMETRIST/OWNER
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Name | DR. RACHAEL M BEATTY
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Credential | OD
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Telephone | 406-272-0453
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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 |
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License Number State |
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