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General NPI Number Information
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NPI Number | 1982749362
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Entity Type | Organization
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Legal Business Name | HAVRE OPTOMETRIC CLINIC, PLLP
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Dates
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Enumeration Date | 02/21/2007
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Last Update Date | 07/06/2015
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Provider Practice Location Address
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Address Line | 416 3RD AVE
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City | HAVRE
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State | MT
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Zip | 59501-3914
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Country | US
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Telephone | 406-265-1231
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Fax | 406-265-1603
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Provider Business Mailing Address
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Address Line | PO BOX 551
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City | HAVRE
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State | MT
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Zip | 59501-0551
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Country | US
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Telephone | 406-265-1231
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Fax | 406-265-1603
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Authorized Official
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Title or Position | PARTNER
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Name | DR. DOUGLAS A SAFLEY
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Credential | OD
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Telephone | 406-265-1231
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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 |
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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 |
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License Number State |
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