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General NPI Number Information
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NPI Number | 1760896781
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Entity Type | Organization
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Legal Business Name | NORTON SOUND HEALTH CORP EYE CLINIC
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Dates
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Enumeration Date | 06/18/2014
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Last Update Date | 06/18/2014
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Provider Practice Location Address
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Address Line | 1000 GREG KRUSCHEK AVE
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City | NOME
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State | AK
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Zip | 99762-0966
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Country | US
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Telephone | 907-443-3311
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Fax | 907-443-3732
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Provider Business Mailing Address
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Address Line | PO BOX 966
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City | NOME
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State | AK
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Zip | 99762-0966
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Country | US
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Telephone | 907-443-3311
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Fax | 907-443-3732
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Authorized Official
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Title or Position | PRESIDENT
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Name | ANGELA F GORN
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Credential |
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Telephone | 907-443-3311
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 152W00000X
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Taxonomy Name | Optometrist
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License Number | 155538
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License Number State | AK
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