Organization
SOUTHEAST OPTICAL INC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MR. CAREY A SWENSON ABO CERTIF OPTICIAN (OWNER MANAGER)
(406) 234-1447
Entity
Organization
Contact information
Practice address
2000 CLARK STREET, MILES CITY, MT 59301
(406) 234-1447
(406) 232-3538
Mailing address
2000 CLARK STREET, MILES CITY, MT 59301
(406) 234-1447
(406) 232-3538
Taxonomy
Speciality
Code
Description
License number
State
156FX1800X
Optician
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
0550001
—
MT
01
—
29628
BLUE CROSS BLUE SHIELD
MT
Enumeration date
03/21/2007
Last updated
08/22/2020
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