MEDICARE: MILES CITY VISION CLINIC P C

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	500	MT

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
3	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1215006416
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	MILES CITY VISION CLINIC P C

Provider Business Mailing Address
First Line	:	1909 MAIN ST
Second Line	:
City	:	MILES CITY
State	:	MT
Zip	:	59301-3724
Country	:	US
Telephone Number	:	406-234-7426
Fax Number	:	406-234-7005

Provider Business Practice Location Address
First Line	:	1909 MAIN ST
Second Line	:
City	:	MILES CITY
State	:	MT
Zip	:	59301-3724
Country	:	US
Telephone Number	:	406-234-7426
Fax Number	:	406-234-7005

Authorized Official
Title or Position	:	OWNER
Name	:	DR. ROBERT DEAN LUNDE
Credential	:	O D
Telephone Number	:	406-234-7426

Provider Enumeration Date	:	11/06/2006
Last Update Date	:	02/17/2012

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Directions to “MILES CITY VISION CLINIC P C ” Practice Location

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