Provider Demographics
NPI:1386808301
Name:HARBERTS, BRENT S (OD)
Entity type:Individual
Prefix:DR
First Name:BRENT
Middle Name:S
Last Name:HARBERTS
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 1:1500 N 7TH AVE
Mailing Address - Street 2:
Mailing Address - City:BOZEMAN
Mailing Address - State:MT
Mailing Address - Zip Code:59715-2557
Mailing Address - Country:US
Mailing Address - Phone:406-585-8153
Mailing Address - Fax:406-586-3734
Practice Address - Street 1:1500 N 7TH AVE
Practice Address - Street 2:
Practice Address - City:BOZEMAN
Practice Address - State:MT
Practice Address - Zip Code:59715-2557
Practice Address - Country:US
Practice Address - Phone:406-585-8153
Practice Address - Fax:406-586-3734
Is Sole Proprietor?:Yes
Enumeration Date:2008-07-18
Last Update Date:2019-11-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN18003528A152W00000X
MT1942152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN200907450Medicaid
INM400071011Medicare PIN
INP00627789Medicare PIN
IN160450UMedicare PIN
IN200907450Medicaid
IN255970CMedicare PIN
IN771580OMedicare PIN
IN669220004Medicare PIN
INM400071017Medicare PIN