Provider Demographics
NPI:1215081567
Name:STIBEL, PATRICK J (OD)
Entity type:Individual
Prefix:MR
First Name:PATRICK
Middle Name:J
Last Name:STIBEL
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 3427
Mailing Address - Street 2:
Mailing Address - City:GREAT FALLS
Mailing Address - State:MT
Mailing Address - Zip Code:59403-3427
Mailing Address - Country:US
Mailing Address - Phone:406-452-9507
Mailing Address - Fax:406-452-2015
Practice Address - Street 1:509 2ND AVE N
Practice Address - Street 2:
Practice Address - City:GREAT FALLS
Practice Address - State:MT
Practice Address - Zip Code:59401-2521
Practice Address - Country:US
Practice Address - Phone:406-452-9507
Practice Address - Fax:406-452-2015
Is Sole Proprietor?:No
Enumeration Date:2007-01-23
Last Update Date:2009-09-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MT470152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MT26540OtherBCBS
MT0480480Medicaid
MT0276530001Medicare NSC
MT26540OtherBCBS
T89257Medicare UPIN