Provider Demographics
NPI:1285606426
Name:OBIE, LARRY G (OD)
Entity type:Individual
Prefix:
First Name:LARRY
Middle Name:G
Last Name:OBIE
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 1569
Mailing Address - Street 2:
Mailing Address - City:CHINOOK
Mailing Address - State:MT
Mailing Address - Zip Code:59523-1569
Mailing Address - Country:US
Mailing Address - Phone:406-357-3740
Mailing Address - Fax:406-357-3640
Practice Address - Street 1:419 PENNSYLVANIA ST
Practice Address - Street 2:
Practice Address - City:CHINOOK
Practice Address - State:MT
Practice Address - Zip Code:59523
Practice Address - Country:US
Practice Address - Phone:406-357-3740
Practice Address - Fax:406-357-3640
Is Sole Proprietor?:Yes
Enumeration Date:2006-02-02
Last Update Date:2018-07-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MT423152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MT0488605Medicaid
MT27220OtherBLUE CROSS/BLUE SHIELD
MT810378264OtherHUMANA
MT810378264OtherMUST
MT810378264OtherSTERLING
MT810378264OtherEBMS
MT0488605Medicaid
MT410011954Medicare UPIN
MTM000002541Medicare PIN
MT27220OtherBLUE CROSS/BLUE SHIELD