Basic Information
| Provider Information | |||||||||
| NPI: | 1578549580 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | HOXIE | ||||||||
| FirstName: | CLINT | ||||||||
| MiddleName: | |||||||||
| NamePrefix: | DR. | ||||||||
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| Credential: | O.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 308 MISSION DR | ||||||||
| Address2: | PO BOX 880 | ||||||||
| City: | ST IGNATIUS | ||||||||
| State: | MT | ||||||||
| PostalCode: | 598659676 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4067453525 | ||||||||
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| Practice Location | |||||||||
| Address1: | 5 4TH AVE E | ||||||||
| Address2: | |||||||||
| City: | POLSON | ||||||||
| State: | MT | ||||||||
| PostalCode: | 598602117 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4068835541 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 12/21/2005 | ||||||||
| LastUpdateDate: | 10/26/2011 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 152W00000X | 752 | MT | Y | Eye and Vision Services Providers | Optometrist | 152WC0802X | 752 | MT | N | Eye and Vision Services Providers | Optometrist | Corneal and Contact Management | 152WP0200X | 752 | MT | N | Eye and Vision Services Providers | Optometrist | Pediatrics |
ID Information
| ID | Type | State | Issuer | Description | 7097623 | 05 | MT | MEDICAID |