Provider Demographics
NPI:1285644120
Name:WHITEFISH EYE CENTER, LLC.
Entity type:Organization
Organization Name:WHITEFISH EYE CENTER, LLC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:ABRETIA
Authorized Official - Middle Name:CRANDELL
Authorized Official - Last Name:OLSON
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:406-471-6561
Mailing Address - Street 1:509 E 6TH ST
Mailing Address - Street 2:
Mailing Address - City:WHITEFISH
Mailing Address - State:MT
Mailing Address - Zip Code:59937-2774
Mailing Address - Country:US
Mailing Address - Phone:406-862-2020
Mailing Address - Fax:406-862-2385
Practice Address - Street 1:509 E 6TH ST
Practice Address - Street 2:
Practice Address - City:WHITEFISH
Practice Address - State:MT
Practice Address - Zip Code:59937-2774
Practice Address - Country:US
Practice Address - Phone:406-862-2020
Practice Address - Fax:406-862-2385
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-09
Last Update Date:2025-04-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MT5869890001Medicare NSC