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General NPI Number Information
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NPI Number | 1730305509
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Entity Type | Organization
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Legal Business Name | PENINSULA EYE CLINIC, APC
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Dates
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Enumeration Date | 04/18/2007
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 161 N BINKLEY ST SUITE 201
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City | SOLDOTNA
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State | AK
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Zip | 99669
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Country | US
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Telephone | 907-262-4462
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Fax | 907-262-3914
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Provider Business Mailing Address
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Address Line | 161 N BINKLEY ST SUITE 201
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City | SOLDOTNA
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State | AK
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Zip | 99669
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Country | US
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Telephone | 907-262-4462
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Fax | 907-262-3914
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Authorized Official
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Title or Position | OWNER
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Name | DR. PETER E CANNAVA
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Credential |
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Telephone | 907-262-4462
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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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