Healthcare Provider Details

I. General information

NPI: 1891282539
Provider Name (Legal Business Name): NORTH POLE EYECARE LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/18/2018
Last Update Date: 04/18/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

145 S SANTA CLAUS LN
NORTH POLE AK
99705-7754
US

IV. Provider business mailing address

PO BOX 55897
NORTH POLE AK
99705-0897
US

V. Phone/Fax

Practice location:
  • Phone: 907-385-3937
  • Fax:
Mailing address:
  • Phone: 907-385-3937
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code152W00000X
TaxonomyOptometrist
License NumberOPTT222
License Number StateAK
# 2
Primary TaxonomyN
Taxonomy Code156FX1800X
TaxonomyOptician
License NumberDOPD259
License Number StateAK

VIII. Authorized Official

Name: DR. MARVIN ACQUISTAPACE
Title or Position: OWNER
Credential: OD
Phone: 907-978-2734