Provider Demographics
NPI:1215066188
Name:PATRICK-PURDY INC
Entity type:Organization
Organization Name:PATRICK-PURDY INC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:TERRY
Authorized Official - Middle Name:C
Authorized Official - Last Name:PATRICK
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:406-293-6236
Mailing Address - Street 1:610 CALIFORNIA AVE
Mailing Address - Street 2:
Mailing Address - City:LIBBY
Mailing Address - State:MT
Mailing Address - Zip Code:59923-1902
Mailing Address - Country:US
Mailing Address - Phone:406-293-6236
Mailing Address - Fax:406-293-6237
Practice Address - Street 1:610 CALIFORNIA AVE
Practice Address - Street 2:
Practice Address - City:LIBBY
Practice Address - State:MT
Practice Address - Zip Code:59923-1902
Practice Address - Country:US
Practice Address - Phone:406-293-6236
Practice Address - Fax:406-293-6237
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-05
Last Update Date:2012-04-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MT689152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MT481525Medicaid
MT000025152Medicare ID - Type UnspecifiedINDIVIDUAL MEDICARE NUMBE
MT000084550Medicare ID - Type UnspecifiedGROUP NUMBER
MT481525Medicaid
MTU16987Medicare UPIN