Individual
LEVI RYAN BLACK
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
OD
Contact information
Practice address
417 MAIN ST SW, RONAN, MT 59864-2738
(406) 676-3937
Mailing address
417 MAIN ST SW, RONAN, MT 59864-2738
(406) 676-3937
Taxonomy
Speciality
Code
Description
License number
State
152W00000X
Optometrist
Primary
OPT-OPT-LIC-4214
MT
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1063764173
—
MT
Enumeration date
06/24/2021
Last updated
06/24/2021
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