MEDICARE: EAST MONTANA VISION CENTER

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	735	MT

General Provider Information

NPI Number	:	1669585519
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	EAST MONTANA VISION CENTER

Provider Business Mailing Address
First Line	:	PO BOX 5030
Second Line	:
City	:	FORSYTH
State	:	MT
Zip	:	59327-5030
Country	:	US
Telephone Number	:	406-346-2020
Fax Number	:

Provider Business Practice Location Address
First Line	:	192 N. 10TH STREET
Second Line	:	BOX 5030
City	:	FORSYTH
State	:	MT
Zip	:	59327
Country	:	US
Telephone Number	:	406-346-2020
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	DR. MARK R. DILL
Credential	:	O.D.
Telephone Number	:	406-346-2020

Provider Enumeration Date	:	08/16/2006
Last Update Date	:	02/14/2014

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Directions to “EAST MONTANA VISION CENTER ” Practice Location

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