Provider Demographics
NPI:1063622496
Name:MICHAEL M. MONSON, O.D., P.C.
Entity type:Organization
Organization Name:MICHAEL M. MONSON, O.D., P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:MARK
Authorized Official - Last Name:MONSON
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:406-494-2222
Mailing Address - Street 1:1221 DEWEY BLVD
Mailing Address - Street 2:
Mailing Address - City:BUTTE
Mailing Address - State:MT
Mailing Address - Zip Code:59701-3413
Mailing Address - Country:US
Mailing Address - Phone:406-494-2222
Mailing Address - Fax:406-494-2263
Practice Address - Street 1:1221 DEWEY BLVD
Practice Address - Street 2:
Practice Address - City:BUTTE
Practice Address - State:MT
Practice Address - Zip Code:59701-3413
Practice Address - Country:US
Practice Address - Phone:406-494-2222
Practice Address - Fax:406-494-2263
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-23
Last Update Date:2020-07-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MT757152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
000084143OtherMCR GROUP #
MTDB 9976OtherRR MCR #
000084143OtherMCR GROUP #