Healthcare Provider Details

I. General information

NPI: 1073417176
Provider Name (Legal Business Name): OPH, INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/05/2026
Last Update Date: 10/05/2026
Certification Date: 10/04/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

564 RIVER DR
CLARK FORK ID
83811-9729
US

IV. Provider business mailing address

564 RIVER DR
CLARK FORK ID
83811-9729
US

V. Phone/Fax

Practice location:
  • Phone: 661-549-0020
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207W00000X
TaxonomyOphthalmology Physician
License Number
License Number StateNULL

VIII. Authorized Official

Name: DR. GEORGE ALEXANDRAKIS
Title or Position: PHYSICIAN
Credential: MD
Phone: 661-549-0020