NPIMap

Organization Active NPI

Marvin John Grendahl MD a Professional Corp.

  • Ophthalmology Physician
  • Anchorage, AK
National Provider Identifier
1063694750
Registry record updated Nov 22, 2011
On this page

Key facts

NPPES NPI Registry
Primary specialty
Ophthalmology PhysicianTaxonomy code 207W00000X
License
MD1417 Issued in AK
Legal business name
MARVIN JOHN GRENDAHL MD A PROFESSIONAL CORP.
Practice address
3500 Latouche St Ste 280
Anchorage, AK 99508-4261
Phone
(907) 561-1917
Fax
(907) 563-5373
NPI assigned
Dec 4, 2007
Last updated
Nov 22, 2011By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Nov 22, 2011

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

Authorized official

Name
Ms. Gail Leingang
Title
Office Admin.
Phone
(907) 561-1917

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Ophthalmology Physician 207W00000X MD3686 AK
Ophthalmology Physician 207W00000X MD1417 AK Primary

Addresses

Primary practice location

3500 Latouche St Ste 280
Anchorage, AK 99508-4261

Mailing address

3500 Latouche St Ste 280
Anchorage, AK 99508-4261
Phone (907) 561-1917

Other identifiers 1

IdentifierTypeStateIssuer
MD1417MedicaidAK

National Provider Directory

National Provider Directory

Locations

3500 Latouche St
Ste 230
Anchorage, AK 99508
Phone (907) 561-1917

3500 Latouche St
Ste 240
Anchorage, AK 99508
Phone (907) 561-1917

3500 Latouche St
Ste 280
Anchorage, AK 99508
Phone (907) 561-1917

Practitioners & affiliated clinicians

Practitioners 6

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

NPI Registry JSON

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

{
    "created_epoch": "1196726400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1321920000000",
    "number": "1063694750",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3500 LATOUCHE ST STE 280",
            "city": "ANCHORAGE",
            "state": "AK",
            "postal_code": "995084261",
            "telephone_number": "907-561-1917",
            "fax_number": "907-563-5373"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3500 LATOUCHE ST STE 280",
            "city": "ANCHORAGE",
            "state": "AK",
            "postal_code": "995084261",
            "telephone_number": "907-561-1917",
            "fax_number": "907-563-5373"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MARVIN JOHN GRENDAHL MD A PROFESSIONAL CORP.",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-12-04",
        "last_updated": "2011-11-22",
        "status": "A",
        "authorized_official_last_name": "LEINGANG",
        "authorized_official_first_name": "GAIL",
        "authorized_official_title_or_position": "OFFICE  ADMIN.",
        "authorized_official_telephone_number": "907-561-1917",
        "authorized_official_name_prefix": "Ms."
    },
    "taxonomies": [
        {
            "code": "207W00000X",
            "taxonomy_group": "",
            "desc": "Ophthalmology",
            "state": "AK",
            "license": "MD3686",
            "primary": false
        },
        {
            "code": "207W00000X",
            "taxonomy_group": "",
            "desc": "Ophthalmology",
            "state": "AK",
            "license": "MD1417",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "MD1417",
            "state": "AK"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Anchorage, AK

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 22, 2011; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.