Provider Demographics
NPI:1487607404
Name:SVENNUNGSEN, ROCK EDWARD (OD)
Entity type:Individual
Prefix:DR
First Name:ROCK
Middle Name:EDWARD
Last Name:SVENNUNGSEN
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 1:925 OILFIELD AVE
Mailing Address - Street 2:
Mailing Address - City:SHELBY
Mailing Address - State:MT
Mailing Address - Zip Code:59474-2703
Mailing Address - Country:US
Mailing Address - Phone:406-434-2763
Mailing Address - Fax:406-434-2904
Practice Address - Street 1:925 OILFIELD AVE
Practice Address - Street 2:
Practice Address - City:SHELBY
Practice Address - State:MT
Practice Address - Zip Code:59474-2703
Practice Address - Country:US
Practice Address - Phone:406-434-2763
Practice Address - Fax:406-434-2904
Is Sole Proprietor?:Yes
Enumeration Date:2006-05-19
Last Update Date:2009-07-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MT446152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
410035739OtherRAILROAD MEDICARE
MT0480324Medicaid
MT0480324Medicaid
MT4154690001Medicare NSC
MTT89262Medicare UPIN