Provider Demographics
NPI:1023231644
Name:HELENA VISION CENTER, PC
Entity type:Organization
Organization Name:HELENA VISION CENTER, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:W
Authorized Official - Middle Name:BRUCE
Authorized Official - Last Name:COEN
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:406-442-6814
Mailing Address - Street 1:PO BOX 844
Mailing Address - Street 2:
Mailing Address - City:HELENA
Mailing Address - State:MT
Mailing Address - Zip Code:59624-0844
Mailing Address - Country:US
Mailing Address - Phone:406-442-6814
Mailing Address - Fax:406-443-7732
Practice Address - Street 1:534 N LAST CHANCE GULCH ST
Practice Address - Street 2:
Practice Address - City:HELENA
Practice Address - State:MT
Practice Address - Zip Code:59601-3303
Practice Address - Country:US
Practice Address - Phone:406-442-6814
Practice Address - Fax:406-443-7732
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-11
Last Update Date:2008-01-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MT449152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MT0480454Medicaid
T89264Medicare UPIN
MT0480454Medicaid