Provider Demographics
NPI:1285609909
Name:MEGUIRE, GERALD EARL (OD)
Entity type:Individual
Prefix:DR
First Name:GERALD
Middle Name:EARL
Last Name:MEGUIRE
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 1:523 9TH ST SOUTH
Mailing Address - Street 2:
Mailing Address - City:GREAT FALLS
Mailing Address - State:MT
Mailing Address - Zip Code:59405
Mailing Address - Country:US
Mailing Address - Phone:406-727-4160
Mailing Address - Fax:406-771-8102
Practice Address - Street 1:523 9TH ST S
Practice Address - Street 2:
Practice Address - City:GREAT FALLS
Practice Address - State:MT
Practice Address - Zip Code:59405
Practice Address - Country:US
Practice Address - Phone:406-727-9160
Practice Address - Fax:406-771-8102
Is Sole Proprietor?:No
Enumeration Date:2006-02-17
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MT399152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MT41002965OtherRR MEDICARE
MT00025780OtherBCBS
MTM000002578OtherPTAN FOR MEDICARE
MT48-7669Medicaid
MTM000002578Medicare PIN
MTM000002578OtherPTAN FOR MEDICARE
MT48-7669Medicaid