| Glendive Eyecare | |
|
115 W Valentine St Glendive MT 59330-1666 | |
| (406) 365-8231 | |
| (406) 365-7081 |
| Full Name | Glendive Eyecare |
|---|---|
| Speciality | Clinic/Center |
| Location | 115 W Valentine St, Glendive, Montana |
| Authorized Official Name and Position | Gary D Jacobsen (PRESIDENT) |
| Authorized Official Contact | 4063658231 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Glendive Eyecare 115 W Valentine St Glendive MT 59330-1666 Ph: (406) 365-8231 | Glendive Eyecare 115 W Valentine St Glendive MT 59330-1666 Ph: (406) 365-8231 |
| NPI Number | 1841461563 |
|---|---|
| Provider Enumeration Date | 03/20/2008 |
| Last Update Date | 07/15/2010 |
| Medicare PECOS PAC ID | 8729119219 |
|---|---|
| Medicare Enrollment ID | O20100628000320 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1841461563 | NPI | - | NPPES |
| 0000026520 | Other | MT | BLUE CROSS BLUE SHIELD |
| 011003935 | Other | MEDICARE PTAN | |
| 048-0350 | Medicaid | MT | |
| 410008748 | Other | MT | RAILROAD MEDICARE |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261Q00000X | Clinic/center | 453 (Montana) | Primary |
| Provider Name | Troy D Myers |
|---|---|
| Provider Type | Practitioner - Optometry |
| Provider Identifiers | NPI Number: 1497914998 PECOS PAC ID: 8123192788 Enrollment ID: I20080731000301 |
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