MEDICARE: PATRICIA M HERNACKI O.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	152W00000X	Optometrist	4936	MT

General Provider Information

NPI Number	:	1154772572
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	PATRICIA M HERNACKI O.D.

Provider Business Mailing Address
First Line	:	301 SADDLE DR STE B
Second Line	:
City	:	HELENA
State	:	MT
Zip	:	59601-8026
Country	:	US
Telephone Number	:	406-442-3937
Fax Number	:	406-442-3366

Provider Business Practice Location Address
First Line	:	301 SADDLE DR STE B
Second Line	:
City	:	HELENA
State	:	MT
Zip	:	59601-8026
Country	:	US
Telephone Number	:	406-442-3937
Fax Number	:	406-442-3366

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/27/2016
Last Update Date	:	04/18/2024

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