Eye Clinic of Fairbanks, Inc

Primary specialty

Ophthalmology PhysicianTaxonomy code 207W00000X

License

292621 Issued in AK

Legal business name

EYE CLINIC OF FAIRBANKS, INC

Practice address

1919 Lathrop St
Suite 103
Fairbanks, AK 99701-5937

Phone

(907) 456-7760

Fax

(907) 451-7916

NPI assigned

Nov 17, 2006

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Ronald W. Zamber, M.D.

Title

President

Phone

(907) 456-7760

Specialties & licenses 2

Addresses

Other identifiers 2

Medicare fee-for-service enrollment

Enrolled in AK

Enrollment records 1

Other NPIs on the same Medicare enrollment 2

NPIs listed together on one Medicare enrollment, typically parts of the same organization.

• Eye Clinic of Fairbanks

  • Optometrist
  • Fairbanks, AK
  • NPI 1396892576

  O20040323000706

  Same enrollment
• Eye Clinic of Fairbanks, Inc

  • Ophthalmology Physician
  • Fairbanks, AK
  • NPI 1689903965

  O20040323000706

  Same enrollment

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1163721600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1340323200000",
    "number": "1003980525",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "116 MINNIE ST",
            "city": "FAIRBANKS",
            "state": "AK",
            "postal_code": "997013006",
            "telephone_number": "907-456-7760",
            "fax_number": "907-451-7916"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1919 LATHROP ST",
            "address_2": "SUITE 103",
            "city": "FAIRBANKS",
            "state": "AK",
            "postal_code": "997015937",
            "telephone_number": "907-456-7760",
            "fax_number": "907-451-7916"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "EYE CLINIC OF FAIRBANKS, INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-11-17",
        "last_updated": "2012-06-22",
        "status": "A",
        "authorized_official_last_name": "ZAMBER",
        "authorized_official_first_name": "RONALD",
        "authorized_official_middle_name": "W.",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "907-456-7760",
        "authorized_official_credential": "M.D."
    },
    "taxonomies": [
        {
            "code": "152W00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Optometrist",
            "state": "AK",
            "license": "292621",
            "primary": false
        },
        {
            "code": "207W00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Ophthalmology",
            "state": "AK",
            "license": "292621",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BLUE",
            "identifier": "A0030",
            "state": "AK"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "MDG576",
            "state": "AK"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Evergreen Health, LLC
• Neal Everson, D.O.
• Exclusively Incusive LLC
• Extended Family Alaska LLC
• Eye Clinic of Fairbanks
• Eye Clinic of Fairbanks, Inc
• Eyemart Express LLC
• Ashley Faiella
• Leslie Fails
• Waverly Fair

• Ophthalmology Physician in Fairbanks, AK
• Providers in Fairbanks, AK by specialty
• Ophthalmology Physician in Alaska

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 22, 2012; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.