Organization
WALMAN OPTICAL COMPANY
Active
Organization subpart
No
Provider details
NPI number
Authorized official
ROBERT F. GUSTIN (VICE PRESIDENT)
(612) 520-6000
Entity
Organization
Contact information
Practice address
410 CENTRAL AVENUE, 320 STRAIN BUILDING, GREAT FALLS, MT 59401
(406) 761-2872
(406) 761-8194
Mailing address
410 CENTRAL AVENUE, 320 STRAIN BUILDING, GREAT FALLS, MT 59401
(406) 761-2872
(406) 761-8194
Taxonomy
Speciality
Code
Description
License number
State
332H00000X
Eyewear Supplier
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
0550043
—
MT
01
—
5520019
CHIP PROVIDER NUMBER
MT
Enumeration date
03/16/2007
Last updated
08/22/2020
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