Healthcare Provider Details

I. General information

NPI: 1912202896
Provider Name (Legal Business Name): ALASKA EYE SURGERY AND LASER CENTER, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/24/2011
Last Update Date: 10/26/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

235 E 8TH AVE STE 3A
ANCHORAGE AK
99501-3662
US

IV. Provider business mailing address

235 E 8TH AVE STE 3A
ANCHORAGE AK
99501-3662
US

V. Phone/Fax

Practice location:
  • Phone: 907-569-1551
  • Fax: 907-569-1564
Mailing address:
  • Phone: 907-569-1551
  • Fax: 907-569-1564

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QA1903X
TaxonomyAmbulatory Surgical Clinic/Center
License Number4540
License Number StateAK
# 2
Primary TaxonomyN
Taxonomy Code261QS0132X
TaxonomyOphthalmologic Surgery Clinic/Center
License Number4540
License Number StateAK

VIII. Authorized Official

Name: DR. ERIC W. COULTER
Title or Position: PRESIDENT
Credential: M.D.
Phone: 907-569-1551