Healthcare Provider Details

I. General information

NPI: 1548391162
Provider Name (Legal Business Name): ALASKA OPTICAL SERVICE,INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/07/2007
Last Update Date: 01/23/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

554 E 3RD AVE
ANCHORAGE AK
99501-2620
US

IV. Provider business mailing address

554 E 3RD AVE
ANCHORAGE AK
99501-2620
US

V. Phone/Fax

Practice location:
  • Phone: 907-278-2020
  • Fax:
Mailing address:
  • Phone: 907-278-2020
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code332900000X
TaxonomyNon-Pharmacy Dispensing Site
License NumberAK0074
License Number StateAK

VIII. Authorized Official

Name: MR. BENJAMIN ALEXANDER WARD III
Title or Position: OWNER
Credential: OPTICIAN
Phone: 907-278-2020