=====================================================
General NPI Number Information
=====================================================
NPI Number | 1871737965
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | NICHOLAS J OKON DO PC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 04/21/2009
-----------------------------------------------------
Last Update Date | 04/21/2009
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 2900 12TH AVE N SUITE 202E
-----------------------------------------------------
City | BILLINGS
-----------------------------------------------------
State | MT
-----------------------------------------------------
Zip | 59101-7506
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 406-237-5545
-----------------------------------------------------
Fax | 406-237-5550
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 2900 12TH AVE N SUITE 202E
-----------------------------------------------------
City | BILLINGS
-----------------------------------------------------
State | MT
-----------------------------------------------------
Zip | 59101-7506
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 406-237-5545
-----------------------------------------------------
Fax | 406-237-5550
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OWNER
-----------------------------------------------------
Name | DR. NICHOLAS JOHN OKON
-----------------------------------------------------
Credential | D.O.
-----------------------------------------------------
Telephone | 406-237-5545
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 2084V0102X
-----------------------------------------------------
Taxonomy Name | Vascular Neurology Physician
-----------------------------------------------------
License Number | 8398
-----------------------------------------------------
License Number State | MT
-----------------------------------------------------