Healthcare Provider Details

I. General information

NPI: 1144921156
Provider Name (Legal Business Name): BRIAN E COE DIABETIC VISION FOUNDATION INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/15/2023
Last Update Date: 03/15/2023
Certification Date: 03/15/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1515 E TUDOR RD STE 7
ANCHORAGE AK
99507-1036
US

IV. Provider business mailing address

1515 E TUDOR RD STE 7
ANCHORAGE AK
99507-1036
US

V. Phone/Fax

Practice location:
  • Phone: 907-206-6000
  • Fax:
Mailing address:
  • Phone: 907-206-6000
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code152W00000X
TaxonomyOptometrist
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code156FX1800X
TaxonomyOptician
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code174H00000X
TaxonomyHealth Educator
License Number
License Number State

VIII. Authorized Official

Name: DAVID PEDIGO
Title or Position: DIRECTOR
Credential: OD
Phone: 907-206-6000