Provider Demographics
NPI:1932370848
Name:ALAN K MONTGOMERY OD
Entity type:Organization
Organization Name:ALAN K MONTGOMERY OD
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:TECHNICIAN/OFFICE MANAGER
Authorized Official - Prefix:MRS
Authorized Official - First Name:SUSAN
Authorized Official - Middle Name:K
Authorized Official - Last Name:SHIRE
Authorized Official - Suffix:
Authorized Official - Credentials:CPOT/ABOC
Authorized Official - Phone:269-782-3476
Mailing Address - Street 1:55021 M 51 N
Mailing Address - Street 2:
Mailing Address - City:DOWAGIAC
Mailing Address - State:MI
Mailing Address - Zip Code:49047
Mailing Address - Country:US
Mailing Address - Phone:269-782-3476
Mailing Address - Fax:269-782-6631
Practice Address - Street 1:55021 M 51 N
Practice Address - Street 2:
Practice Address - City:DOWAGIAC
Practice Address - State:MI
Practice Address - Zip Code:49047
Practice Address - Country:US
Practice Address - Phone:269-782-3476
Practice Address - Fax:269-782-6631
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-03-19
Last Update Date:2008-03-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4901002313152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI0673520001Medicare NSC
MIU20234Medicare UPIN