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General NPI Number Information
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NPI Number | 1942221221
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Entity Type | Organization
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Legal Business Name | SOLDOTNA OPTOMETRY CLINIC, LLC
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Dates
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Enumeration Date | 07/21/2006
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Last Update Date | 02/19/2008
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Provider Practice Location Address
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Address Line | 155 SMITH WAY SUITE 202
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City | SOLDOTNA
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State | AK
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Zip | 99669-8060
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Country | US
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Telephone | 907-262-3168
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Fax | 907-262-5458
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Provider Business Mailing Address
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Address Line | 155 SMITH WAY SUITE 202
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City | SOLDOTNA
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State | AK
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Zip | 99669-8060
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Country | US
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Telephone | 907-262-3168
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Fax | 907-262-5458
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Authorized Official
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Title or Position | SOLE OWNER
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Name | DR. JOHN A. DEMSKE
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Credential | O.D.
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Telephone | 907-262-3168
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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 | #87
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License Number State | AK
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