Healthcare Provider Details

I. General information

NPI: 1467565531
Provider Name (Legal Business Name): CLEAR VISION OPTOMETRY, INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/16/2006
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1867 AIRPORT WAY SUITE 150-A
FAIRBANKS AK
99701-4007
US

IV. Provider business mailing address

1867 AIRPORT WAY SUITE 150-A
FAIRBANKS AK
99701-4007
US

V. Phone/Fax

Practice location:
  • Phone: 907-452-2191
  • Fax: 907-452-2618
Mailing address:
  • Phone: 907-452-2191
  • Fax: 907-452-2618

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261Q00000X
TaxonomyClinic/Center
License Number312847
License Number StateAK

VIII. Authorized Official

Name: MS. BRENDA NABER
Title or Position: OFFICE MANAGER
Credential:
Phone: 907-452-2024