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General NPI Number Information
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NPI Number | 1346830403
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Entity Type | Organization
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Legal Business Name | SITENGA EYE ASSOCIATES LLC
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Dates
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Enumeration Date | 01/22/2021
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Last Update Date | 01/22/2021
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Provider Practice Location Address
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Address Line | 115 BIDARKA ST
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City | KENAI
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State | AK
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Zip | 99611-7741
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Country | US
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Telephone | 907-335-3358
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Fax | 907-335-4358
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Provider Business Mailing Address
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Address Line | 115 BIDARKA ST
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City | KENAI
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State | AK
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Zip | 99611-7741
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Country | US
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Telephone | 907-335-3358
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Fax | 907-335-4358
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Authorized Official
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Title or Position | SOLE OWNER
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Name | GARRET LAMENDOLA SITENGA
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Credential | MD
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Telephone | 907-335-3358
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207W00000X
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Taxonomy Name | Ophthalmology Physician
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License Number |
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License Number State |
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