Provider Demographics
NPI:1053342006
Name:LEONARD E. VAINIO & DAVID G. VAINIO PC
Entity type:Organization
Organization Name:LEONARD E. VAINIO & DAVID G. VAINIO PC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OPTOMETRIST
Authorized Official - Prefix:DR
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:G
Authorized Official - Last Name:VAINIO
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:406-563-6471
Mailing Address - Street 1:100 W PARK AVE
Mailing Address - Street 2:
Mailing Address - City:ANACONDA
Mailing Address - State:MT
Mailing Address - Zip Code:59711-2259
Mailing Address - Country:US
Mailing Address - Phone:406-563-6471
Mailing Address - Fax:406-563-7252
Practice Address - Street 1:100 W PARK AVE
Practice Address - Street 2:
Practice Address - City:ANACONDA
Practice Address - State:MT
Practice Address - Zip Code:59711-2259
Practice Address - Country:US
Practice Address - Phone:406-563-6471
Practice Address - Fax:406-563-7252
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-06
Last Update Date:2014-07-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MT426152W00000X
MT490152W00000X
MT3128207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Multi-Specialty
No207W00000XAllopathic & Osteopathic PhysiciansOphthalmologyGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MT000482137Medicaid
MT000482256Medicaid
MTD08606062OtherSUBMITTER ID
MTP00005738OtherRAILROAD MEDICARE
MT000482256Medicaid
MTD08606062OtherSUBMITTER ID
MT000082427Medicare PIN
MT25114Medicare ID - Type UnspecifiedB.GUNTER-MEDICARE