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General NPI Number Information
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NPI Number | 1932383627
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Entity Type | Organization
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Legal Business Name | MONTANA EYECARE MISSOULA, PC
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Dates
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Enumeration Date | 12/18/2007
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Last Update Date | 08/31/2025
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Provider Practice Location Address
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Address Line | 726 KENSINGTON AVE
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City | MISSOULA
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State | MT
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Zip | 59801-5720
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Country | US
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Telephone | 406-549-9413
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Fax | 406-543-4410
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Provider Business Mailing Address
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Address Line | 726 KENSINGTON AVE
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City | MISSOULA
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State | MT
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Zip | 59801-5720
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Country | US
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Telephone | 406-549-9413
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Fax | 406-543-4410
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. JONATHAN ROBERT BUNDY
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Credential | O.D.
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Telephone | 406-549-9413
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 332H00000X
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Taxonomy Name | Eyewear Supplier
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License Number | 564
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License Number State | MT
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Taxonomy #2
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Taxonomy Code | 152W00000X
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Taxonomy Name | Optometrist
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License Number | 564
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License Number State | MT
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