Provider Demographics
NPI:1194747055
Name:STREMCHA, GARY (OD)
Entity type:Individual
Prefix:
First Name:GARY
Middle Name:
Last Name:STREMCHA
Suffix:
Gender:M
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 551
Mailing Address - Street 2:
Mailing Address - City:HAVRE
Mailing Address - State:MT
Mailing Address - Zip Code:59501-0551
Mailing Address - Country:US
Mailing Address - Phone:406-265-1231
Mailing Address - Fax:406-265-1603
Practice Address - Street 1:416 3RD AVE
Practice Address - Street 2:
Practice Address - City:HAVRE
Practice Address - State:MT
Practice Address - Zip Code:59501-3914
Practice Address - Country:US
Practice Address - Phone:406-265-1231
Practice Address - Fax:406-265-1603
Is Sole Proprietor?:No
Enumeration Date:2006-07-23
Last Update Date:2007-11-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MT510152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MT48-3613Medicaid
MT27360OtherBC/BS OF MT
T81780Medicare UPIN