Provider Demographics
NPI:1225209513
Name:ADVANCED EYECARE LLC
Entity type:Organization
Organization Name:ADVANCED EYECARE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CREDENTIALING
Authorized Official - Prefix:
Authorized Official - First Name:SONIA
Authorized Official - Middle Name:K
Authorized Official - Last Name:BECKER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:406-577-2507
Mailing Address - Street 1:91 W MADISON AVE STE B
Mailing Address - Street 2:
Mailing Address - City:BELGRADE
Mailing Address - State:MT
Mailing Address - Zip Code:59714-3915
Mailing Address - Country:US
Mailing Address - Phone:406-388-1988
Mailing Address - Fax:406-388-2488
Practice Address - Street 1:4265 FALLON ST STE 1
Practice Address - Street 2:
Practice Address - City:BOZEMAN
Practice Address - State:MT
Practice Address - Zip Code:59718-6797
Practice Address - Country:US
Practice Address - Phone:406-577-2507
Practice Address - Fax:406-587-0396
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:ADVANCED EYECARE LLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2008-03-14
Last Update Date:2021-06-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MT0492152W00000X
332BC3200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
No332BC3200XSuppliersDurable Medical Equipment & Medical SuppliesCustomized EquipmentGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MT0481767Medicaid
MT000002823Medicare PIN
MT6165870001Medicare NSC