Healthcare Provider Details

I. General information

NPI: 1881905172
Provider Name (Legal Business Name): MARCY LORRAINE O'NEIL O.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/01/2010
Last Update Date: 07/22/2026
Certification Date: 07/22/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5955 ZEAMER AVE
JBER AK
99506-3702
US

IV. Provider business mailing address

27947 RAVEN CT
CHUGIAK AK
99567-5111
US

V. Phone/Fax

Practice location:
  • Phone: 907-580-2020
  • Fax: 907-580-1152
Mailing address:
  • Phone: 802-917-3943
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code152W00000X
TaxonomyOptometrist
License Number140405
License Number StateAK

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: