Organization
NORTHWEST FAMILY EYE CARE
Active
Organization subpart
No
Provider details
NPI number
Authorized official
TANNER LIGHTBOURNE OD (PRESIDENT)
(406) 293-6236
Entity
Organization
Contact information
Practice address
610 CALIFORNIA AVE, LIBBY, MT 59923-1902
(406) 293-6236
Mailing address
610 CALIFORNIA AVE, LIBBY, MT 59923-1902
(406) 293-6236
Taxonomy
Speciality
Code
Description
License number
State
152W00000X
Optometrist
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1164092425
PERSONAL NPI NUMBER
MT
01
—
4229
OPTOMETRY LICENSE NUMBER
MT
Enumeration date
08/03/2021
Last updated
11/11/2021
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