Healthcare Provider Details

I. General information

NPI: 1568760783
Provider Name (Legal Business Name): VILLAGE EYE WEAR INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/11/2011
Last Update Date: 10/01/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

205 E BENSON BLVD
ANCHORAGE AK
99503-4019
US

IV. Provider business mailing address

205 E BENSON BLVD
ANCHORAGE AK
99503-4019
US

V. Phone/Fax

Practice location:
  • Phone: 907-317-5201
  • Fax:
Mailing address:
  • Phone: 907-317-5201
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code152W00000X
TaxonomyOptometrist
License Number60
License Number StateAK
# 2
Primary TaxonomyN
Taxonomy Code156FX1800X
TaxonomyOptician
License Number207
License Number StateAK

VIII. Authorized Official

Name: MS. TAMMY E COLLINGS
Title or Position: MANAGER
Credential: OPTICIAN
Phone: 907-317-5201