NPIMap

Organization Active NPI

Agape Peninsula Eye Care, LLC

  • Optometrist
  • Clam Gulch, AK
National Provider Identifier
1154749653
Registry record updated Dec 12, 2017
On this page

Key facts

NPPES NPI Registry
Primary specialty
OptometristTaxonomy code 152W00000X
License
334 Issued in AK
Legal business name
AGAPE PENINSULA EYE CARE, LLC
Practice address
55562 Razor CT
Clam Gulch, AK 99568
Phone
(907) 252-2285
Fax
(888) 623-2285
NPI assigned
Apr 1, 2014
Last updated
Dec 12, 2017By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Dec 12, 2017

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

Authorized official

Name
Dr. Marilyn K Holm, O.D.
Title
Owner/Member
Phone
(907) 252-2285

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
OptometristGroup: 193400000X SINGLE SPECIALTY GROUP 152W00000X 334 AK Primary

Addresses

Primary practice location

55562 Razor CT
Clam Gulch, AK 99568

Mailing address

PO Box 287
Clam Gulch, AK 99568-0287
Phone (907) 252-2285

National Provider Directory

National Provider Directory

Practitioners & affiliated clinicians

Practitioners 1

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": "1396310400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1513036800000",
    "number": "1154749653",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 287",
            "city": "CLAM GULCH",
            "state": "AK",
            "postal_code": "995680287",
            "telephone_number": "907-252-2285",
            "fax_number": "888-623-2285"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "55562 RAZOR CT",
            "city": "CLAM GULCH",
            "state": "AK",
            "postal_code": "99568",
            "telephone_number": "907-252-2285",
            "fax_number": "888-623-2285"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "AGAPE PENINSULA EYE CARE, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2014-04-01",
        "last_updated": "2017-12-12",
        "status": "A",
        "authorized_official_last_name": "HOLM",
        "authorized_official_first_name": "MARILYN",
        "authorized_official_middle_name": "K",
        "authorized_official_title_or_position": "OWNER/MEMBER",
        "authorized_official_telephone_number": "907-252-2285",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "O.D."
    },
    "taxonomies": [
        {
            "code": "152W00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Optometrist",
            "state": "AK",
            "license": "334",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Clam Gulch, AK

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 12, 2017; 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.