Provider Demographics
NPI:1396398442
Name:BIG SKY EYES PC
Entity type:Organization
Organization Name:BIG SKY EYES PC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:DOCTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:ERICA
Authorized Official - Middle Name:
Authorized Official - Last Name:PERLMAN - HENSEN
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:909-576-6398
Mailing Address - Street 1:99 TOWN CENTER AVE, UNIT #A6
Mailing Address - Street 2:P.O. BOX # 160700
Mailing Address - City:BIG SKY
Mailing Address - State:MT
Mailing Address - Zip Code:59716
Mailing Address - Country:US
Mailing Address - Phone:406-414-0006
Mailing Address - Fax:
Practice Address - Street 1:99 TOWN CENTER AVE, UNIT #A6
Practice Address - Street 2:
Practice Address - City:BIG SKY
Practice Address - State:MT
Practice Address - Zip Code:59716-0700
Practice Address - Country:US
Practice Address - Phone:406-414-0006
Practice Address - Fax:406-414-0004
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-07-18
Last Update Date:2019-10-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Multi-Specialty
No152WC0802XEye and Vision Services ProvidersOptometristCorneal and Contact ManagementGroup - Multi-Specialty
No152WL0500XEye and Vision Services ProvidersOptometristLow Vision RehabilitationGroup - Multi-Specialty
No152WP0200XEye and Vision Services ProvidersOptometristPediatricsGroup - Multi-Specialty
No152WS0006XEye and Vision Services ProvidersOptometristSports VisionGroup - Multi-Specialty
No152WX0102XEye and Vision Services ProvidersOptometristOccupational VisionGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MT1063865590Medicaid