Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 152W00000X | Optometrist | 557 | MT |
NPI | 1003025974 |
---|---|
Provider Name | Dr. Robert J Sherer |
First Address | Great Falls, MT 59405-3449 |
Second Address | Great Falls, MT 59405-3449 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 21/05/2007 |
Last Update Date | 27/12/2016 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
0483067 | (05) | MT |
27940 | BCBS (01) | |
V22404 | (02) | MT |