NPIMap

Individual provider Active NPI

Annelle Glee Maygren, O.D.

  • Optometrist
  • Craig, AK
National Provider Identifier
1477556488
Registry record updated Nov 7, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
OptometristTaxonomy code 152W00000X
License
297 Issued in AK
Practice address
333 Cold Storage Road
Craig, AK 99921
Phone
(907) 755-4967
Fax
(907) 755-2414
NPI assigned
May 23, 2005
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Nov 7, 2022

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

Specialties & licenses 3

Specialty (taxonomy)CodeLicenseStatePrimary
Optometrist 152W00000X 12333T CA
Optometrist 152W00000X 2964T OR
Optometrist 152W00000X 297 AK Primary

Addresses

Primary practice location

333 Cold Storage Road
Craig, AK 99921

Mailing address

3100 Channel Dr Ste 300
Juneau, AK 99801-7837
Phone (907) 463-4074

Other identifiers 2

IdentifierTypeStateIssuer
1023212MedicaidAK
OPTT297OtherAKSTATE OF ALASKA

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in TX
Eligible to order & refer
  • Part B services
  • Medical equipment
  • Home health
  • Power mobility devices
  • Hospice
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20120710000689 TX Practitioner - Optometry 4688745805 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Optometry
Education
Pacific University - College of Optometry, 2003
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Southeast Alaska Regional Health Consortium 373 clinicians

Practice addresses (Care Compare)

333 Cold Storage Rd
Craig, AK 99921-0655
Phone (907) 755-4986

Hospital & facility affiliations

  • Southeast Alaska Regional Health Consortium Hospital, Sitka, AK, CCN 021314

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
12333CAMDProfessional Counselor
297AKMDOptometrist
2964TORMDOptometrist

Practice roles

OrganizationSpecialtyStatusNew patients
Southeast Alaska Regional Health Consortium Current Accepting new patients
Southeast Alaska Regional Health Consortium CurrentSince Jun 25, 2012 Accepting new patients
Southeast Alaska Regional Health Consortium Current Accepting new patients
Southeast Alaska Regional Health Consortium CurrentSince Jun 25, 2012 Accepting new patients
Maygren Family Eye Care Optometrist PastSince Oct 3, 2011 Accepting new patients
Shasta Vision Group an Optometric Corporation Optometrist PastSince Apr 30, 2003 Accepting new patients

Locations

3100 Channel Dr
Ste 300
Juneau, AK 99801
Phone (907) 463-4000

222 Tongass Dr
Sitka, AK 99835
Phone (907) 966-8423

Interoperability endpoints

  • Direct secure messaging: amaygren@direct-searhc.org

Organizations & group practices 13

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

View all 13

Hospital & facility affiliations 35

Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.

View all 35

NPI Registry JSON

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

{
    "created_epoch": "1116806400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1667779200000",
    "number": "1477556488",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3100 CHANNEL DR STE 300",
            "city": "JUNEAU",
            "state": "AK",
            "postal_code": "998017837",
            "telephone_number": "907-463-4074",
            "fax_number": "907-463-1510"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "333 COLD STORAGE ROAD",
            "city": "CRAIG",
            "state": "AK",
            "postal_code": "99921",
            "telephone_number": "907-755-4967",
            "fax_number": "907-755-2414"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MAYGREN",
        "first_name": "ANNELLE",
        "middle_name": "GLEE",
        "credential": "O.D.",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2005-05-23",
        "last_updated": "2022-11-07",
        "certification_date": "2022-11-04",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "152W00000X",
            "taxonomy_group": "",
            "desc": "Optometrist",
            "state": "CA",
            "license": "12333T",
            "primary": false
        },
        {
            "code": "152W00000X",
            "taxonomy_group": "",
            "desc": "Optometrist",
            "state": "OR",
            "license": "2964T",
            "primary": false
        },
        {
            "code": "152W00000X",
            "taxonomy_group": "",
            "desc": "Optometrist",
            "state": "AK",
            "license": "297",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1023212",
            "state": "AK"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "STATE OF ALASKA",
            "identifier": "OPTT297",
            "state": "AK"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Craig, AK

Sources for this page

Verify at the official NPI Registry.