Active NPI
Eye Clinic of Fairbanks
- Optometrist
- Fairbanks, AK
National Provider Identifier
1396892576
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Optometrist
- Legal business name
- EYE CLINIC OF FAIRBANKS
- Practice address
- 1001 Noble St
Suite 410
Fairbanks, AK 99701-4922 - Phone
- (907) 458-7768
- NPI assigned
- Jan 3, 2007
- Organization subpart
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Authorized official
- Name
- Joseph E Beaty
- Title
- Billing Agent
- Phone
- (907) 770-2301
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Optometrist | 152W00000X | Primary |
Addresses
Primary practice location
1001 Noble St
Suite 410
Fairbanks, AK 99701-4922
Mailing address
PO Box 241769
Anchorage, AK 99524-1769
Phone (907) 770-2301
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Enrolled in AK
Enrollment records 1
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| O20040323000706 | AK | Part B Supplier - Clinic/Group Practice | 7719878370 |
Receives reassigned benefits from 9 practitioners 2 other NPIs on this enrollment This NPI is an additional NPI on the enrollment Practice locations: Fairbanks, AK |
Other NPIs on the same Medicare enrollment 2
NPIs listed together on one Medicare enrollment, typically parts of the same organization.
National Provider Directory
National Provider DirectoryNPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1167782400000",
"enumeration_type": "NPI-2",
"last_updated_epoch": "1288915200000",
"number": "1396892576",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "PO BOX 241769",
"city": "ANCHORAGE",
"state": "AK",
"postal_code": "995241769",
"telephone_number": "907-770-2301",
"fax_number": "907-770-2325"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1001 NOBLE ST",
"address_2": "SUITE 410",
"city": "FAIRBANKS",
"state": "AK",
"postal_code": "997014922",
"telephone_number": "907-458-7768"
}
],
"practiceLocations": [],
"basic": {
"organization_name": "EYE CLINIC OF FAIRBANKS",
"organizational_subpart": "NO",
"enumeration_date": "2007-01-03",
"last_updated": "2010-11-05",
"status": "A",
"authorized_official_last_name": "BEATY",
"authorized_official_first_name": "JOSEPH",
"authorized_official_middle_name": "E",
"authorized_official_title_or_position": "BILLING AGENT",
"authorized_official_telephone_number": "907-770-2301"
},
"taxonomies": [
{
"code": "152W00000X",
"taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
"desc": "Optometrist",
"state": null,
"license": null,
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Fairbanks, AK
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 5, 2010; 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.